Introduction

In Poland, it is my babcia’s 80th birthday, but she did not know it herself because of how much her dementia had progressed. She sat at the head of the table with a confused pout on her face and her head down. Her head was down as she fumbled with a small napkin on her lap, its surface patterned with two colorful flowers. She would nervously fold the napkin and unfold it and fold it again with shaky hands as if she was trying to fix it. Then she would trace the flower’s shape with her finger as if it were the only thing that was real to her, the only thing she understood at a birthday table surrounded by her family.  She needed something to distract her as we spoke around her. Then, on the radio, an old 60’s Polish song starts playing, called “Mamo moja jada goscie,” a song she would sing all the time as a child growing up in the traditional part of Poland called Kurpie. She stops fiddling with the tiny paper and looks up and smiles, then rocking back and forth, she sings “la” along to the song. Her voice followed the song as if it never left her, and she tapped her hand to the beat. She finally seemed present, and the whole family joined alongside her. After being isolated the whole dinner, we found a way to show my babcia how much love surrounded her on her special day. By the end of the song, her sister goes to hug her, and she hugs back and kisses her on the cheek. She knew it was her.

These experiences with my grandmother inspired me to learn more about her impairment. Cognitive impairment can take away a skill and take away a person’s sense of who they are. However, such impairment should not have to mean being isolated or socially disappeared. Because music operates through subcortical circuits that remain functional, even when explicit language, motor, or memory processing is damaged or overridden, music can bypass that impairment and reach the parts of a person’s brain that are still intact, restoring not only function but also personhood. Understanding this function on paper was not enough for me — I needed to see it for myself.  This particular power led me to explore this possibility during my internship at Mount Sinai’s Louis Armstrong Center for Music & Medicine, as I worked alongside music therapists like Kristen and Dr. Rossetti, and researchers like Tammy.

The Power of Music, Broadly Defined

Music profoundly influences us. It has lived with and within us for as long as humans have existed. Music serves many different purposes, including emotional, physical, symbolic, and social ones, for a diverse range of groups of people.

The power of music is shown in how it can physically reshape your brain. When music interacts with the brain, all parts of the brain are active. Perception, movement, memory, and emotion are all being exercised in a way an isolated task never would. That whole-network engagement is what builds plasticity, and plasticity is what eventually allows music to do something no other stimulus reliably can: reach around damage instead of through it. This is monumental because the brain is connected to the body, and the body functions through the signals it sends. So ultimately, when exercising a part of the brain to improve it, the bodily function that part of the brain controls will also improve, which is exactly what opens the door to bypassing impairment in the first place. Hallam and Himonides state that “music has a multiplicity of functions which operate at several levels: that of the individual, the social group and society in general” (Hallam and Himonides 4), showing that music can not be reduced to a singular function and its power is plural, plasticity only being the first piece of it.

A person’s emotions are among the most complex concepts a person holds, and the hardest part of a person to access directly. You can be the most articulate person, but states like grief, love, longing, and fear can be hard to put into words fully. However, music does not have that limitation. It can carry the shape of an emotion in a way language cannot. That is why someone can hear a song and break into tears without knowing why. The emotional power of music lies in the fact that it is not just a sound to enjoy, but an access point. Music serves as “a vehicle for emotional expression, conveying ideas and emotions which might be difficult to communicate in ordinary verbal interchanges” (Hallam and Himonides 5), reaching feelings that language cannot form. This concept will be important later in this paper because I will address how it influences a person who loses language altogether.

As strong as music is for its effect on the individual listener, it also holds tremendous social power. When music shifts from an individual personal experience to a shared experience, it takes on new meaning. Making music together creates a synchronized experience that’s built in real time. This synchrony does not just feel like connection — it becomes connection, at the level of brain chemistry, because it “creates and strengthens social bonds amongst interacting group members through endorphins, which are released during synchronized exertive movements in singing or playing together” (Hallam and Himonides 6). Shared music-making requires something of people that listening alone does not. It forces people to be vulnerable with their voice, timing, and imperfect participation. For someone with a cognitive impairment or mental illness, shared music experiences can offer a comfortable way to be seen without judgment and to stop being isolated and engage in the present moment. This is why “music fosters prosocial behavior, a shared sense of success, physical coordination, shared attention, shared motivation and group identity” (Hallam and Himonides 6) because it gives people a reason to lower their guard together. When music is shared, it does not just shape an individual and their emotions; it also shapes who “we” are and forms a group’s identity. This is similar to what sociologist Émile Durkheim calls “collective effervescence,” the heightened, almost electric sense of unity that arises when a group moves and feels something together, dissolving the boundary between individual and collective in the process. Durkheim was describing religious ritual, but the mechanism he described is the same one at work when a room full of strangers finds the same beat.

Beyond its power to connect people, music does something even more fundamental. Music does not just go through one ear and out the other; it physically alters your brain. Hallam and Himonides state that making music “draws on many brain functions, including those related to perception, action, cognition, emotion, learning and memory” (Hallam and Himonides 16). In other words, it moves through the whole system at once and is not confined to a single narrow pathway, as most single tasks are. This engagement with music is not short-lived. Over time, “extensive active engagement with music induces cortical reorganization, producing functional changes in how the brain processes information” (Hallam and Himonides 18). The brain is altering itself in a way that lasts and not just responding to music. Some clinical research suggests that music’s neurological power does not stop at the level of conscious thought.

According to Stephen Porges, the neuroscientist behind Polyvagal Theory, music also communicates directly with the autonomic nervous system, the part of the nervous system that regulates safety and threat, and operates completely outside conscious control. Andrew Rossetti, a music therapist who directs oncology music therapy at Mount Sinai, draws directly on Porges’ work. He explains that music “supports connectedness and co-regulation” and “communicates cues of safety to our nervous system,” which “down-regulate defense and optimize homeostatic processes” (Rossetti, ‘Environmental Music Therapy’ 135). This is not just theoretical and actually holds up under clinical testing. In a randomized clinical trial testing this mechanism in a radiation oncology waiting room, patients who received live, therapeutic music showed a significant drop in anxiety. Their anxiety had a median decrease of 16.6 points on a standard anxiety scale, compared to an increase in the control group (Rossetti et al., 2023, ‘A Clinical Pilot Study’ 58). If Porges’ theory explains why music can calm a nervous system that it never consciously reaches, this trial proves that it actually does. Music has been shown to interact with the brain on a whole other, unconscious level.

This unconscious quality of music is not a new revelation either; it is something researchers have speculated about for over a century. The philosopher Friedrich Nietzsche, who devoted himself to music and philosophy, put it, “we listen to music with our muscles” — a line the neurologist Oliver Sacks returns to in his own writing on music and the brain (qtd. in Sacks 2528). Kristen, another music therapist I worked alongside during my internship at Mount Sinai, echoed the same idea, saying, “music moves the muscles.” With Porges’ theory and Rossetti’s data, we can see that this is not just speculation. Music actually engages the body and brain as a single system, which is what makes listening to music such a distinct experience. 

If music’s neurological power lies in its ability to engage the brain and body as a connected system, then its critical significance lies in what happens when part of that system is damaged. For example, language relies heavily on specific and fragile brain regions responsible for grammar, word retrieval, and speech production, concentrated mostly in the left hemisphere. Music, on the other hand, draws on a much wider, more redundant network involving rhythm, pitch, and melody, which is processed in both the right and left hemispheres, in areas associated with movement, memory, and emotion. The two systems intersect at points, but they are not built on the same foundation, which means an injury precise enough to knock out language can still leave music’s broader network largely intact. Hallam and Himonides second this, saying, “clinical studies of those with brain damage revealed separate deficits in music and language” (Hallam and Himonides 46). In other words, a person can lose the ability to comprehend speech or to speak while their capacity for music remains completely untouched, and vice versa. This is what allows music to reach certain pathways and reach a person when language cannot, or they are impaired.

The Bypass Mechanism

This is exactly what happened to my babcia at our own dinner table. She sat in a wordless state due to her dementia, taking almost all speech away– until the melody of  “Mamo moja jada goscie” reached her.   Something inside her answered back. Looking at this mechanism more closely, I see that this separation between music and language is not something I noticed by chance. It has a name and a direct clinical application: melodic intonation therapy. For example, rather than asking a patient to speak, therapists sing sentences to them in an exaggerated, musical version of normal speech until it resembles a song. As Hallam and Himonides explain, this technique, developed by “Sparks and colleagues (1974)”, works by using “sung intonation of propositional sentences in such a way that the intoned pattern is similar to the natural prosodic pattern of the sentence when it is spoken” (74). The patients Sparks studied were not easy fixes. They were “eight severely, but not globally, impaired right-handed aphasic subjects with left hemisphere damage,” each of whom “had shown no improvement in verbal expression for at least six months” of standard language therapy (Hallam and Himonides 74-75).

This is the idea behind bypassing cognitive impairment: the therapy works not by forcing language back in through the original damaged pathway, but by rerouting it through music instead. My babcia was never enrolled in a clinical trial, but she is living proof of the same mechanism at work. Why is music able to bypass so many different types of damage, such as those affecting language, hearing, or memory? Part of the explanation goes deeper than any single neural pathway, reaching into the brain’s most ancient reward systems. The pleasure we get from music stimulates what neuroscientist Stefan Koelsch describes as “a phylogenetically old reward network that functions to ensure the survival of the individual and the species” (Koelsch 170). In other words, music does not depend on the same evolutionarily more recent circuits that language relies on. Instead, it has its own much older route into the brain, one that can remain intact even when more recent systems break down.

Kristen shared something a woman with Alzheimer’s said to her during a session: “I feel like I have forgotten more than I have ever known.” This is what daily pain is like with Alzheimer’s. It is not one dramatic loss but a subtle, contrasting awareness of disappearing until it has all gone. That is what a disease like dementia takes away from someone: not just words, but the certainty of who you were before you lost them. Music therapy cannot bring back everything that is gone, but it can reach and bring out the person that is underneath all that forgetting.

This idea of neurological bypassing can apply to any compromised system, and the effectiveness of music therapy in accomplishing this is supported by Hallam and Himonides, who summarize a study by Good and colleagues (2017) on children with cochlear implants. The children who received music training showed improved discrimination of melodic contour and rhythm, incidental memory for melodies, and emotional speech prosody perception, whereas a matched group given painting lessons showed no such improvements (Hallam and Himonides 74). This means the benefit was specific to music, not simply structured attention or care.

Work like this is also implemented in the Newborn Intensive Care Unit for premature infants. During my volunteer work at Mount Sinai, I observed music therapy in the Level IV neonatal intensive care unit, the Jo Carol and Ronald S. Lauder NICU. My mentor, Tammy, was studying how entrainment — matching the tempo of live singing to a baby’s breathing and heartbeat — affects oxygen and respiratory stability in infants born with conditions like Respiratory Distress Syndrome (RDS). While we do not yet have research findings, I observed it in practice at the hospital. I observed a baby with a small adhesive sensor strip on his forehead, connected to a near-infrared spectroscopy (NIRS) machine that tracked his fractional tissue oxygen extraction — a measure of how well the brain is receiving oxygen. As Tammy sang a soft jazz tune, matching her tempo to his breathing, he drifted off to sleep, and his vital signs remained stable throughout. This mirrors what Virtala and Partanen found in older infants: that ‘music-making and parental singing prompted infants’ early language development and auditory neural processing’ (Hallam and Himonides 74). Here, “bypass” is not the right word because there is not yet a damaged language pathway for music to route around. Instead, music arrives first to stabilize the nervous system before language has even begun to form, so that when language does emerge, it has a steadier foundation to build on.

The bypass also extends to motor impairment. Earlier this year, I heard this principle explained directly by David Leventhal, founding teacher of Dance for PD, in a talk at a conference on music and medicine called “Mechanism of Pain and Music.” Leventhal described the patients who arrived rigid, frozen, sometimes barely able to initiate a single step, and the patients who left moving with fluidity and grace once music and rhythm entered the room — the same body transformed by an external beat. There is a real mechanism behind this happening. Parkinson’s disease damages the brain’s internal timing system, the one responsible for cueing smooth, sequenced movement. Researchers explain “PD is associated with a loss of internal cueing systems, affecting rhythmic motor tasks such as walking,” but that “music and dance encourage spontaneous rhythmic coupling between sensory and motor systems” (Krotinger and Loui). The mechanism, they argue, works because rhythmic training can strengthen “neural pathways involved in motor control, auditory-motor entrainment, action observation, and/or kinesthetic or proprioceptive feedback mechanisms that could then be utilized as an alternative to impaired motor areas” (Krotinger and Loui). This means that rhythmic training builds alternative neural pathways that can substitute for the internal timing system the disease has damaged.

Leventhal described people in his dance classes learning to forget that movements are commands sent from their brains to their bodies, and to use music and rhythm to shift what they do from a common action to something they create. I think of it like this: instead of thinking of walking as moving your feet in front of each other, one at a time, you use the rhythm of the music to make it an action of moving from stone to stone across a calm river. Then, soon after creating these new scenarios, people who could take a step learn to create these full dances. The body is not relearning how to move. It is borrowing a rhythm it can no longer generate on its own.

What struck me most, though, was not the mechanism – it was what Leventhal said about identity. Parkinson’s, he explained, “affects every aspect of a person’s sense of self.” But in his classes, patients are given “a new identity — that of dancer, instead of just patient” (“David Leventhal”). That distinction is not small. It is, in miniature, the entire argument of this paper: the bypass is not just of a damaged motor pathway, but of an erased identity.

So far, every population in this section has had a body or brain system that was physically compromised. PTSD complicates that picture — the injury is not structural, but the isolation it produces looks remarkably similar. Combat-related PTSD often produces ‘feelings of loneliness and isolation from society, intrusive memories, outbursts of anger and generalized feelings of helplessness’ (Bensimon, Amir, and Wolf 34). Traumatic memories resist the kind of verbal processing ordinary memories allow — they are stored as raw sensory fragments, leaving many survivors unable to translate what happened into words at all. This is often called “the unspeakable,” however, I would push back slightly on where the block actually sits. It may also be that people around them cannot bear to listen to it, and that unwillingness closes a door that survivors might otherwise have tried to open. Music offers a route around that block: because music and trauma are both “sensory mediated,” music therapy can function “as a means of sensory approach to traumatic memories as a detour of linguistic and logical mediation” (Bensimon, Amir, and Wolf 40)—a way to reach a survivor without requiring either side of that broken exchange to work first.

In a study of six soldiers diagnosed with combat- or terror-related PTSD, group drumming produced measurable “increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy” (Bensimon, Amir, and Wolf 34). One participant described the effect directly: “Once you beat the drum, although you don’t know anyone, it gives a feeling of togetherness which makes it possible for you to share everything with the group. It’s as if you’ll go naked in front of them. . . If something facilitated intimacy above all the instruments, it was the drums” (Bensimon, Amir, and Wolf 38). These soldiers were already receiving individual psychotherapy alongside the drumming session, yet it was the drumming, specifically, that participants pointed to when describing this particular kind of openness. That distinction matters. It shows that rhythm reached something in these men that conversation, on its own, had not yet reached.  

Mania presents a different kind of impairment altogether– not a damaged pathway, but a mind in crisis. A recent randomized study of 102 inpatients hospitalized for manic episodes found that those who received group therapy alongside routine nursing care showed significantly lower mania severity scores and significantly higher emotional stability scores than those who received routine care alone. This shows that the intervention “significantly enhances emotional stability and satisfaction among hospitalized manic patients” (“Effect of Group Music Therapy” e46082). Here, the damage was to the mind’s instability in general and not to a single damaged circuit that needs to be routed around. And still, music reached something that routine clinical care alone did not.

As I explain later in this paper, I would witness this effect firsthand in a room full of patients diagnosed with schizophrenia, bipolar disorder, and psychosis.

Wholeness as the Goal, Not Just Function

Bypassing impairment at the level of the brain is only half the picture. For many patients, the deeper impairment is not neurological at all but the isolation that the illness produces, and reaching a person there requires more than rerouting a damaged circuit. It requires community. Music therapy and community music are not quite the same thing, and the distinction matters here. As MacGlone and colleagues explain, “community music interventions are distinct as they may have positive therapeutic outcomes, but these are secondary to the realization of an enjoyable, sociable experience for participants” (MacGlone et al. 2). In other words, community music does not set out to fix anything. It sets out to include someone, and healing comes as a byproduct of that inclusion rather than the goal. This reframes the word “treatment” from correcting something to restoring someone’s wholeness.

That reframing matters because isolation is not a side effect of illness — it is often part of the injury itself. “Isolation due to social exclusion is a key contributing factor to such mental health impacts” (MacGlone et al. 2), and the reverse is just as true: reducing isolation can itself be a form of treatment, not just a pleasant side benefit of one. Nowhere is this clearer than in the case of Jack, a young man with a disability who took part in a community music program studied by researchers at the University of Edinburgh. In the year before the program began, his mother had watched him steadily withdraw, losing interest in things that once brought him joy. A month of medical investigation turned up no clear cause, though doctors suggested depression. Then the music workshops started. According to a staff member, Jack “came back to life,” joining with enthusiasm he had not shown in over a year, cracking jokes again, playing with expectations during the group’s songs the way he once had. His mother described it: “It’s like seeing the old Jack… they’ve just seen bits of him that’s like they used to see years ago, coming back.” (MacGlone et al. 8). What is striking about Jack’s case is what did not happen. Nothing about his underlying diagnosis changed. No pathway was repaired, no circuit rerouted. And yet something unmistakable had come back. That gap is the clearest possible illustration of what “wholeness” means in this paper. It is not the absence of impairment, but the presence of the person who was there all along, however hidden the impairment had made them.

This idea has a name, specifically in dementia care. Psychologist Tom Kitwood defined personhood as “a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being,” adding that it “implies recognition, respect and trust” (qtd. in Tieu and Matthews). I keep coming back to that word “bestowed.” Kitwood is not saying that personhood is something a person has, locked safely away, no matter what happens to them. He is saying it is something given continuously by the people around them, which means it can also be withheld. A caregiver, doctor, or distracted family member can fail to bestow it through impatience, talking over someone instead of listening, and by treating a diagnosis as the whole of who that person is. Doing this can erode a personhood that no brain scan would ever show as damaged. This reframes what happened to Jack, and what happens every time my babcia sings. Neither the community music workshop nor my babcia’s song repaired anything measurable. But both moments gave back something that had quietly gone missing. For Jack, that was a sense of self his withdrawal had taken from him, and for my babcia, that was a place in her own family’s conversation, which her dementia had left her locked out of. What came back in both cases was not a restored function but recognition finally being offered again.

One of the researchers behind Jack’s program, Kirsty Brown, who has a disability herself and worked as a lay researcher on the study, gave this phenomenon the name “voice”. She defined voice as a form of self- expression that does not have to be verbal at all — participants could “sing, speak, play instruments,” but just as often, their voice showed up as “increased eye contact with others, bodily movement or gesture” (MacGlone et al. 6). Voice, in other words, is not the same thing as speech. It is whatever a person still has left to offer those around them, in whatever form it takes.

My babcia’s voice, that night at the dinner table, was a single syllable repeated in place of words she could no longer find: “la, la, la,” pitched exactly where the lyrics should have been. It was enough to bring her back.

None of this is merely an observation, and it does not apply only to dementia and disabilities. A ten-year follow-up study of people living with first-episode psychosis found that rates of “personal recovery,” “life satisfaction,” and “pleasure” were all higher than rates of “clinical recovery” — the disappearance of symptoms (Simonsen et al. 2112). In fact, “personal recovery overlapped more with emotional wellbeing than with clinical recovery” (Simonsen et al. 2118). Sixty-eight percent of participants had achieved at least one positive outcome after ten years, leading the researchers to conclude that a “good life with psychosis” was possible (Simonsen et al. 2112). This is the finding, stated in the language of psychiatric research rather than music therapy, that this entire paper has been circling. Wholeness was never the same as the absence of impairment and does not require a cure; it requires only what Kitwood said it does: constant recognition, respect, and trust. Sometimes that comes through a clinical trial. Sometimes it comes through a drum circle, a dance class, or a single syllable, sung at a dinner table, by a woman who lost the words but not the voice. Comprehending all of this can be done through reading, but watching it happen in front of your eyes in a room is so much more than an article can convey.

“It Brings Me Life”

I entered the “inpatient adult and geriatric psychiatric service unit” on the hospital’s fourth floor. The space is intimidating because people roam freely, and this section of the hospital is where patients with serious mental illness reside. . . It is my first time working with patients in these conditions, so I don’t know how to act. Not because I don’t want to be there, but because I can be standing two feet away from someone and have no clue what is going through their mind or what’s real and what’s not for them.

Patients carry their droopy faces as they drift, pace, and prowl around freely without reason. One person approached and stood closely behind me. In the common area, sets of eyes stare blankly at a TV playing. The eyes are not even watching the screen; they are just fixed there, not blinking or moving away.

The therapy room is different from the hallways. It’s clean and simple with a little bookshelf in the corner for patients to use. The chairs are arranged in a circle, with tables in the center, creating a sense of both distance and connection. Patients trickle in slowly, and I watch them carefully as each of their eyes darts around the room, trying to find the chair in the circle they feel the safest in. A guy on my left aggressively scratches his head and fixates on things around the room while the girls across from him look down rapidly tapping their feet. Then there is an older man at the end, and he is sitting back in his chair with his hands under the table, folded in his lap, his attention on the instruments placed down the middle of the circle. Kristen told me he rarely stays for the full sessions, trying to remain in his comfort zone. The feeling in the room feels uncertain until Kristen, the facilitator, asks a simple question. “What do you like about music?” People around the circle answer one at a time, and the old man at the end says, “It brings me life.” Kristen slowly starts playing her guitar and singing “Waiting on the World to Change” softly, almost under her breath. The soft strums allow everyone to drift into the shared experience comfortably. The instruments laid out are simple, nothing too sharp-sounding or jarring, like maracas, shakers, and small hand drums. Most people start reaching for instruments to play, whether it’s just to have something to hold or to add to the sound. The room, once filled with silence, drifts into a mix of different sounds, so softly played together, and the instruments disappear to the beat of the song Kristen is now singing.

Kristen stops singing at some point, and more questions about change and pushing people out of their comfort zones follow. I have previously learned some of their diagnoses, like schizophrenia, psychosis, and bipolar disorder, but as they play together and answer Kristen’s questions, their diagnoses disappear, and they turn into more complex humans. The older man finally grabs a small drum and a stick and plays so softly under all the other music that you can barely make it out. But as the bridge comes, he smiles and starts to sing along with Kristen. He stays for the full session.

Why This Matters: The Cost of Calling Music Optional

Nothing in this article is new information. The evidence for music therapy’s power to bypass impairment and restore personhood is not new, not thin, and not controversial within the field. And yet music therapy remains, in practice, an afterthought. Music therapy is treated as something offered when there is room in the budget, rather than built into the structure of care itself. Part of the reason is that music therapy does not fit neatly into a healthcare system built around pharmaceuticals and procedures. These things can be billed, coded, and reimbursed on a predictable schedule. A pill has a price, and a scan has a code. A conversation between a music therapist and a patient, no matter how transforming, often does not have that role in the patient’s treatment plan. As one recent review of music therapy in healthcare puts it plainly, “in many healthcare facilities and community settings, music therapy remains inconsistently funded, often relying on charitable support or short-term grants” (Lan et al.). Charity and short-term grants are not what you build a system of care on. They are what you build a program on and can be cut when the budget needs to be tightened.

This is not a problem of ignorance. The same researchers note that even mainstream medicine has been forced to take non-pharmacological approaches seriously, precisely because of “the limited efficacy and certain adverse drug reactions (ADRs)” of the drugs doctors have relied on instead (Lan et al.). In other words, the medical system already knows the current model has real costs, measurable harm, and real limits. It has turned to music therapy anyway due to necessity and not out of conviction. Funding has not kept pace with the growing evidence.

The disparity is not evenly distributed, either. Music therapy “has been formally recognized as a professional field in numerous Western countries, such as the United States, Canada, the United Kingdom, and Australia; yet, in many low- and middle-income countries. . . There is a lack of standardized recognition and proper reimbursement mechanisms” (Lan et al.). Access to a person’s own personhood being restored should not have to depend on where that person happens to live and how much money goes into the healthcare system they are born into.

This concept is the most visible in long-term and nursing home care — the exact setting where Kitwood’s model of personhood was first developed, because it was in those settings that he saw personhood most routinely eroded. A resident in a facility built around cost containment is, structurally, a line item before they are a person — a bed to fill, a set of medications to administer on schedule, a body to keep alive as efficiently as possible. Bestowing personhood, Kitwood’s word (constant recognition, respect, trust), takes time, attention, and staff who are not stretched so thin they cannot give it. None of that shows up on a balance sheet as a cost saved. It shows up, if it shows up at all, as a resident who is easier to manage, calmer, and less likely to need intervention. These are all outcomes a spreadsheet can register, even when it cannot register the reason behind them.

The researchers behind this same review are unambiguous about what needs to change: “government, clinicians, insurers, and healthcare payers must recognize music therapy as a reimbursable health service. . . establishing reimbursement pathways or national funding frameworks would legitimize music therapy as a part of the formal, standard practice” (Lan et al.). This is not a radical claim, nor is it strictly about music. It is a claim about what a healthcare system chooses to count as a real treatment, and what it allows itself to treat as an option or just a nice, extra form of care. That extra form of care has reached people like no pill can.

My babcia is fortunate because she has family who can give her the music that she cares about. Not every patient with dementia, not every survivor of trauma, not every person losing themselves has that. Whether they do should not rely on what a hospital’s budget can absorb this year. It should depend on what we, as a system that claims to care for people and not just their symptoms, are willing to call essential.

Conclusion

I wanted to write a paper like this as soon as I saw my babcia reawakened from a 60-year-old song that found an opening into her being. I needed to know more about what I had witnessed. I found that what reached her was not a miracle, but a mechanism. Music and language are not the same communication modality, no matter how intertwined they are, and if one is damaged, the other is not. The same rerouting that allowed her to sing was the reason a man rigid with Parkinson’s moved again after hearing a rhythm his own brain could no longer generate, and why deaf children were able to learn to hear speech through rhythm. This bypass is more than strengthening an area of the brain to restore a daily function because it is actually able to reach people with issues that do not impact a function but take over their entire mental stability: people with trauma so severe they cannot put it into words have used music to overcome it. This is possible because music’s influence on the brain is older than language itself and foundational enough to remain after other parts of the brain have been compromised. However, on closer inspection, it is apparent that none of this is actually the point. A bypassed pathway is not the goal, but restoring the person is. What is actually happening when my babcia starts singing a song she once knew, when a shy man opens up to a group of strangers, every time Jack “comes back to life”, is closer to what Kitwood called bestowal. The quiet, repeated act of recognizing someone as a person, respecting them as one, and trusting that they are still there to be reached.

The larger argument of this paper is that music can help heal and that neurological impairment does not have to mean disappearance. Music is one of the most powerful ways we have found to meet a person where they are. It should not be a luxury or a grant-funded extra but a requirement. We are born with one heart and one body, so if there is a way to prevent impairment from taking who we are away from the one life we have, there should be no discussion.

My babcia still goes through every day with dementia, and there is no cure. However, knowing that we can achieve those little moments where my babcia and others are not lost forever restores hope — not that the disease like this one will stop taking, but that what they take can still, sometimes, be given back.

References

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About the author

Maya Nakahara

Maya Nakahara is a student in the Instrumental Music program at LaGuardia High School, where she plays piano and trumpet and has recently started learning guitar. Her academic interests sit at the intersection of music, neuroscience, and therapeutic application — an interest she has pursued through volunteer work at Mount Sinai’s Louis Armstrong Center for Music & Medicine. Outside the classroom, she plays volleyball for her school’s varsity team and for Brooklyn Elite Volleyball, a club team, and serves as the Event Manager for her school’s Mental Health Initiative.

The post How Can Music Bypass Impairment to Reach The Wholeness of a Person? appeared first on Exploratio Journal.

Abstract

Though the term was not coined until recent decades, scholars have written about individuals who fit the description of what we now call attention deficit hyperactivity disorder (ADHD) for centuries. The current paper reviews the history of ADHD, its diagnostic criteria, and reasons behind rising diagnosis rates. It then applies the evolutionary mismatch hypothesis to argue that ADHD traits, though challenging in modern settings, may have been adaptive in ancestral environments. Finally, it examines research linking ADHD to creativity, focusing on divergent thinking, real-world creative achievement, and mind wandering.

History of ADHD

Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the most common disorders that affects attention and behavior. Even though ADHD is widely known today, modern researchers have noted that earlier scholars have reported deficits in some children’ s abilities to pay attention, control their actions, and stay focused on tasks for hundreds of years (e.g., Lange et al., 2010; Martinez-Badia & Martinez-Raga, 2015). According to Lange and colleagues (2010), one of the earliest descriptions came from a Scottish doctor named Alexander Crichton in the late 1700s who wrote about people who seemed unable to keep their attention on one thing for very long. He observed that some individuals were easily distracted by things happening around them and found it difficult to maintain attention on tasks, which often interferes with learning and education (Lange et al., 2010). Additionally, Martinez-Badía & Martinez-Raga (2015) recount that in 1902 British doctor George Frederick Still described children who had difficulty controlling their behavior even though they were intelligent. It noted that these children were often aggressive, defiant, resistant to discipline, and also had difficulty in concentrating or learning from the consequences of their actions despite having normal intelligence (Martinez-Badía & Martinez-Raga, 2015). Today, many researchers believe that the children he described likely had ADHD (e.g., Lange et al., 2010; Martinez-Badía & Martinez-Raga, 2015; Taylor, 2011).

As doctors learned more about the brain, they started to look for medical explanations for behaviors that had previously been seen as problems with discipline or poor self-control. During the middle of the twentieth century, ADHD was often linked to problems in brain development that could affect behavior (Martinez-Badía & Martinez-Raga, 2015). Different names were used over time, including “Minimal Brain Dysfunction” and “Hyperkinetic Reaction of Childhood,” reflecting changing ideas about the condition. These terms focused mainly on hyperactivity, but they also helped shift attention away from blaming children for their behavior and toward medical explanations. As these ideas became more widely accepted, ADHD came to be recognized as a medical condition rather than simply bad behavior or poor discipline. Over time, the diagnosis and treatment of ADHD expanded beyond North America and became more common in many parts of the world. In 1980, the American Psychiatric Association introduced the term “Attention Deficit Disorder” (ADD) in the DSM-III, recognizing that difficulties with attention were a major part of the condition. Later editions changed the name to Attention-Deficit/Hyperactivity Disorder (ADHD), which is still used today. This process of treating ADHD as a medical condition contributed to the global acceptance of ADHD, and today it is considered one of the most common neurodevelopmental disorders, with studies estimating that about 5% of children and adolescents worldwide are affected by the condition (Conrad & Bergey, 2014). Although scientists did not fully understand ADHD during its early development, these changes helped shape the modern understanding of the disorder (Martinez-Badía & Martinez-Raga, 2015).

Common Characteristics and Diagnostic Criteria

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to diagnose ADHD. According to the DSM-5, symptoms must begin before the age of twelve. ADHD affects people in different ways, but most symptoms fall into two main groups: inattention and hyperactivity-impulsivity (American Psychiatric Association, 2022). Some people mainly struggle with attention, while others mainly struggle with hyperactivity and impulsive behavior. Many people experience a combination of both. Lange and colleagues (2010) reported that researchers as early as Crichton observed individual differences in these characteristics throughout the population. Modern researchers report that these two symptom types have differing impacts on the daily lives of individuals with ADHD (Knouse et al. 2008). People with inattentive symptoms often have difficulty focusing on tasks for a long time. They may forget assignments, lose important items, become easily distracted, or have trouble following directions. In school, these students may understand the material but still struggle because they miss details or lose focus during class. Hyperactive and impulsive symptoms are different. A person with these symptoms may have trouble sitting still, feel restless, talk a lot, interrupt others, or act before thinking. Young children with ADHD may run around or move constantly. Older teenagers and adults may not be physically hyperactive, but they may still feel restless inside.

The absence or presence of each of the two types of symptoms results in three types of presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Individuals with the predominantly inattentive presentation often struggle with sustaining attention, organization, and completing tasks, while those with the predominantly hyperactive-impulsive presentation are more likely to exhibit excessive movement, impulsive behavior, and difficulty remaining still. The combined presentation includes significant symptoms from both categories and is generally associated with greater overall impairment than either presentation alone (Ghaderi et al., 2017; Willcutt et al., 2012). The symptoms must also appear in more than one setting, such as at school and at home. In addition, the symptoms must cause real difficulties in daily life. However, ADHD symptoms may not appear the same in every environment. Adolescents with ADHD have been found to report higher levels of symptoms on school days than on non-school days. Symptoms also tend to worsen throughout the day and often reach their highest levels during the afternoon. These findings suggest that the demands of different settings, such as school and home, can influence how ADHD symptoms are expressed (Pedersen et al., 2020).

ADHD can affect school performance, friendships, and everyday responsibilities. However, not every person with ADHD experiences the same challenges. Some people have mild symptoms, while others have more serious difficulties. Because ADHD affects people differently, proper evaluation and diagnosis are important.

Historical Trends and Modern Rates

ADHD diagnoses have become more common over the last several decades. Today, experts estimate that about 5.29% of children worldwide have ADHD (Polanczyk et al. 2007). In some countries, especially the United States, diagnosis rates are even higher (Centers for Disease Control and Prevention [CDC], 2024). This increase has led many people to ask whether ADHD is becoming more common or whether doctors are simply getting better at identifying it. Many researchers believe that better diagnosis is a major reason for the increase (e.g., Martin et al. 2025; Sayal et al. 2017), while others suggest that increases in ADHD rates may also reflect increased misdiagnosis (e.g., Abdelnour et al., 2022). Teachers, parents, and doctors now know much more about ADHD than they did in the past. As a result, children who may have been misunderstood years ago are more likely to receive help today.

Changes in diagnostic rules have also affected the number of diagnoses. As doctors learned more about ADHD, the definition of the disorder became clearer. This allowed more people with symptoms to be recognized and diagnosed. Some researchers believe that modern society may also play a role (e.g., Kazda et al., 2021; Sayal et al., 2018;). Modern schools often require students to sit still for long periods, pay attention during lectures, and complete structured assignments. These expectations can make ADHD symptoms easier to notice. Technology may also affect attention in some ways, although scientists continue to study this issue (e.g., Domingues-Montanari, 2017; Nikkelen et al., 2014; Ra et al., 2018).

While experts continue to debate the exact reasons for increasing diagnosis rates, most agree that greater awareness and better evaluation methods are important factors (e.g., Kazda et al., 2021;Sayal et al., 2018). Thus, it appears that more people are being identified because ADHD is now better understood than it was in the past.

ADHD and Creativity

ADHD is also becoming increasingly understood as a cluster of characteristics that are not objectively “disordered” but that are moreso poorly matched with our modern human environment. The evolutionary mismatch hypothesis posits that many human traits evolved to help our ancestors survive in past environments but may not function as well in today’s rapidly changing world (Lloyd et al., 2011). As a result, characteristics that were once adaptive can appear maladaptive when they no longer match the demands of modern environments. Perhaps the most well-known example of evolutionary mismatch wherein our innate psychology produces poor outcomes in modern settings has to do with eating behavior and obesity. Humans evolved in environments where food was often scarce, so storing energy efficiently and consuming calorie-rich foods increased the chances of survival. In modern societies, however, the widespread availability of inexpensive, high-calorie foods combined with sedentary lifestyles creates an evolutionary mismatch that contributes to high rates of obesity (Sellayah et al., 2014).  Norman and colleagues (2018) further highlight that the evolutionary mismatch hypothesis applies to ADHD among other issues and make note of the implications of evolutionary mismatches for psychological science and public policy. Those implications include designing environments and interventions that better match evolved human psychology instead of working against it. The authors argue that understanding evolutionary mismatches can help researchers develop more effective policies to improve physical and mental health and address problems in modern society.

With this understanding that ADHD characteristics are not inherently flawed but rather mismatched with many aspects of modern environments, we can begin to explore the ways in which ADHD characteristics are related to traits and outcomes that are perceived. One such positive characteristic is creativity. Researchers have long noticed a link between ADHD traits and creative thinking, especially divergent thinking (e.g., White & Shah, 2006). Divergent thinking is the ability to come up with many different ideas or solutions to one open problem. This skill is different from convergent thinking, which means finding one correct answer through logical steps (Runco & Jaeger, 2012).

Several studies show that people with higher ADHD symptoms often score well on divergent thinking tasks. White and Shah (2006; 2011; 2016) found that adults with ADHD produced more ideas, more different types of ideas, and more original ideas than adults without ADHD. White and Shah (2006) used the Unusual Uses Task to test this, and also found ADHD adults scored worse on a task requiring one single correct answer. In their 2011 paper, the same authors found that ADHA adults also reported more real-world creative achievement, such as engaging in artistic pursuits or creative writing (White & Shah, 2011). In yet another followup, White and Shah (2016) further unpacked the relationship between ADHD and creativity by showing ADHD minds activate a wider, more flexible network of word associations, giving them more raw material for original ideas. This pattern suggests that while ADHD traits like distractibility and impulsivity cause problems in school or work settings, other ADHD traits might actually help people think in more flexible and open ways

However, the connection between ADHD and creativity is not simple and not all studies support a clear connection. Healey and Rucklidge (2006) tested children with and without ADHD using creativity tests and found no clear difference between the two groups. A more recent review of 31 studies by Hoogman and colleagues (2020)  also found mixed results. It reported that divergent thinking was linked to higher ADHD symptoms mainly in people who showed ADHD traits but did not have a clinical diagnosis. Among people who had an actual clinical diagnosis, the results were less consistent (Hoogman et al., 2020). This means that having a few ADHD-like traits might support creative thinking, but having a full, severe form of ADHD does not always lead to the same benefit.

Even with these mixed results, one finding appears fairly steady across studies: people with ADHD often show strong creative achievement in daily life. Creative achievement means real-world creative output, such as writing, art, music, invention, or new business ideas, rather than just scores on a lab test. Hoogman et al. (2020) noted that both people with a clinical ADHD diagnosis and people with subclinical ADHD traits reported higher levels of everyday creative achievement compared to people without these traits. This suggests that the ADHD mind may not always shine in a structured testing room, but it often shines in open, flexible, real-life situations where new ideas are needed.

Why would this happen? One possible answer connects back to the evolutionary mismatch idea. In ancestral environments, quick shifts in attention could have helped early humans notice new threats, spot unexpected food sources, or explore new territory (Hoogland & Ploeger, 2022). A mind that jumps between ideas, notices small details others miss, and feels drawn to new and different stimuli may have supported exploration and problem-solving in a world that was less structured and less repetitive than modern schools or offices. Today, this same style of thinking can look like a lack of focus in a classroom. But in an open, creative task, the same style of thinking can produce many new and useful ideas.

Mind wandering is another trait connected to this pattern. Mind wandering happens when a person’s thoughts drift away from the main task and move to unrelated ideas (Smallwood & Schooler, 2006). Mind wandering is common in ADHD (Seli et al., 2015). It is often seen as a weakness because it can reduce performance on repetitive or boring tasks (Mooneyham & Schooler, 2013). Yet some studies link mind wandering to stronger divergent thinking, since a wandering mind naturally makes new and unusual connections between ideas (Yamaoka et al., 2020). In other words, a trait that looks like poor focus in a mismatched environment can become an advantage in a creative environment that welcomes free thinking.

Together, these findings support the evolutionary mismatch view of ADHD. The same traits that cause trouble in a traditional classroom or a strict nine-to-five job, such as restlessness, quick shifts in attention, and a pull toward novelty, may also support flexible, original thinking. Instead of framing ADHD only as a set of deficits, researchers increasingly argue for a more balanced view. This view sees ADHD traits as tools that were shaped by an older environment and that still hold value today, especially in fields that reward new ideas rather than repetitive routine. This shift in framing does not deny real challenges that come with ADHD. It simply asks us to look at the full picture, including the strengths, rather than only the difficulties that appear in mismatched modern settings.

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About the author

Youngwoo Nam

Youngwoo is a student at Avon Old Farms School in Connecticut with strong interests in mathematics, behavioral science, and entrepreneurship. He has pursued advanced mathematics through accelerated coursework, earning A+ grades in both Algebra II/Trigonometry and Calculus, and participated in Cornell SCE Precollege Studies. He has also developed a strong interest in research. As a research assistant under Dr. Isaac Dilanni, he investigated the relationship between part-time employment and adolescents’ academic performance and long-term outcomes. Outside the classroom, he is involved in Environmental Club, Math Club, and Entrepreneurship Club, while competing in hockey and lacrosse and participating in wrestling. Beyond academics and athletics, he has demonstrated a commitment to community involvement through volunteer work and athletic operations at his school. He is also interested in drawing and sculpture and speaks English, Korean, and Spanish.

The post Understanding ADHD and Its Association with Creativity appeared first on Exploratio Journal.

Abstract

Suicide rates have risen in the last two decades and the endemic remains a pressing social concern. There are nearly 45,000 suicides and 1.2 million suicide attempts per year in the United States. Current mitigation efforts are generally focused on mental health and subsequent psychiatric analysis. They have largely been ineffective in reversing the rise in suicide rates. However, suicide remains a significant problem that can be approached with a new lens. Social factors such as the prevalence of guns, media reporting, and classification systems are still poorly understood, especially when compared to conventional mental health strategies. This paper analyzes how the individualistic concept of suicide produces misunderstandings, how these misunderstandings hinder progress, and how solutions that acknowledge the public and social factors controlling suicide can help mitigate the growing suicide crises.

Introduction

When twenty-eight-year-old Kevin Baldwin released himself off the side of the Golden Gate Bridge, he felt the shocking reality that “everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.” Baldwin represents one of the millions of Americans who attempt suicide each year. In 2020, according to the CDC, there were 45,979 suicides and nearly 1.2 million suicide attempts in the United States, while suicide rates had slowly risen to 13.5 suicides per 100,000, making it a leading cause of death and a prominent social issue within the nation. Nevertheless, Baldwin’s attempt and his subsequent survival also reflect key misunderstandings about suicide that reveal the potential for new mitigation approaches.

There are several fundamental misunderstandings of the suicide endemic which shape the public understandng of the problem. These include the following: the belief that suicides are long thought-out, premeditated actions, that people who attempt will inevitably reattempt, that mental illness is always tied to suicide, that we can best predict (and understand) suicide from a psychopathological perspective, and lastly, that suicide is an issue predominantly tied to the individual. As such, mitigation efforts, which are often focused on the examination of individuals and individual mental health issues, remain limited given these misconceptions. They continue to fixate on individual assessment, when in reality, the suicide endemic is more nuanced and complex than this conventional approach proposes. Furthermore, the over-fixation on an individualistic lens distracts the public from a relatively feasible, attainable, and immediate set of strategies for mitigating suicide, ones that are often overlooked in the vast response to a national mental health issue.

Given this, a reconsideration of suicide mitigation efforts is necessary. Rather than fixate on individual-level approaches, we can better tackle the problem with a broader understanding of the larger social factors that are at play. this paper explores the misconceptions surrounding suicide and their realities using a thorough analysis of the research on suicide. It details how misconceptions inhibit mitigation strategies, and how more immediate and sensible strategies can be instituted through a better understanding of crucial social determinants of suicide.

Contemporary Misconceptions Regarding Suicide

Introduction

A mere google search, using keywords, can quickly reveal public misconceptions regarding suicide; A browser finds images focused on individuals, often contemplating on their own, and displaying mental distress. There is rarely acknowledgment of public or social factors that may be involved, and the concept of individual mental illness is the dominant framing.

Suicides are Long Thought Out and Inevitable Events

Whether it is Vanity Fair describing Robin Williams’ suicide as the result of a “long and difficult decline” or the Rolling Stone describing Kurt Cobain’s from the perspective of a “downward spiral”, conventional knowledge surrounding suicide and its most famous cases displays a perspective of deliberation, decline, and inevitability. While mental health struggles often precede suicides, a hindsight bias is employed in the aftermath of a suicide attempt. Mental health issues are prescribed as superordinate, or lone, causes of prolonged and unavoidable paths to suicide. Therefore, working with the mental health model, individuals are thought to engage in a prolonged or continued contemplation stage before moving towards suicidal behaviors. This idea creates the conception of inevitable and elongated decline, often presenting as the cause surrounding celebrity and community suicides. On the contrary, there is nothing inevitable about a suicide attempt. Many attempts unfold in short periods and out of temporary crises that provoke immediate and impulsive suicidal actions. (Deisenhammer et al., 2009) analyzed eighty-two patients admitted after a suicide attempt and found that nearly 74% of patients had found the jump from a decision to an attempt to be short (10 minutes or less) and 47% traversed the entire suicidal process (including consideration, decision, and action) within ten minutes of first consideration. Furthermore, researchers concluded, “The process from the emergence of suicidal thoughts to the accomplishment of a suicide attempt, and thus the time for intervention, generally is short”. Another study (Williams et al., 1980 ), analyzing visits to Australian hospitals, noted that a considerable majority of suicidal behavior was impulsive and that nearly 40% of analyzed subjects had acted within five minutes of suicidal premeditation.

These studies provide insight into the impulsive and erratic nature of suicides that is not recognized within mitigative and informational discussions surrounding suicides and suicide attempts. Instead of a calculated decision, a suicide attempt can be characterized by a temporary heightening of turmoil and vulnerability. Interestingly, suicide notes, another concept behind the idea of thought-out suicides, are indeed more rare than conceded by popular understanding. Of nearly 3,000 suicides analyzed in a six-year study by the American organization of suicidology, a small proportion, slightly above 18%, left a suicide note (Cerel et al., 2014). Serving as an indicator of a thought-out process, the lack of suicide notes highlights a propensity for rapid decision-making concerning suicide. As such, suicide attempts are often impulsive, arrive at times of heightened susceptibility and vulnerability, and are all but inevitable. This evidence opposes the common conception of deliberate suicidal processes. It is one of the central realities facing one of the more significant misconceptions surrounding suicide and hindering its mitigation strategies.

More Attempts Will Follow Suicide Failures

In a Harvard opinion survey published in 2006, nearly 74% of respondents believed that if individuals who attempted suicide via jumping off the Golden Gate Bridge had been deterred, they would have been able to complete suicide at another time and through other means regardless. This survey points to another misunderstanding surrounding suicide, the belief that individuals who attempt suicide will often reattempt if their first attempt is non-fatal. In this fashion, this understanding suggests that suicide mitigation can be a futile and overwhelming process. By extention, it follows that treatment should occur within the context of repeated attempts by individuals who continue to present suicidal behaviors and who may inevitably reach a fatal attempt by sheer force of will, regardless of mitigation strategies. However, within the knowledge that suicides are oftentimes impulsive decisions, the realities presented can compound into a more nuanced and hopeful understanding. Nearly nine of every ten individuals who attempt suicide but survive will not die of suicide at a later date. A study ( Owens et al., 2018) affirmed this understanding when it found that in nine years following a suicide attempt, only 7% of patients within a series of studies and databases had fatally relapsed, and nearly 70% never reattempted.

Coming back to the topic of Golden Gate attempters, an analysis (Seiden, 1978) found that of five hundred and fifteen individuals who attempted suicide at the Golden Gate Bridge but had been deterred or survived, only about 10% (35/515) had gone on to die by suicide at a later date. This study supposes a near 90% post-attempt survival rate, one which the public, and respondents in the survey mentioned above, do not acknowledge. As such, it can be supposed that with proper rehabilitation and support, individuals who attempt suicide, survive, and progress past the lapse of vulnerability will be less likely to reattempt than common knowledge suggests and unlikely to reattempt at large. Therefore the mere idea of suicidal inevitability within individuals who have attempted is inaccurate and detrimental to mitigation strategies, and the assumption that reattempts are common distracts from the necessity of preventing suicide means and attempts on hand, as well as from other mitigation strategies.

Mental Health is the Only Factor in Suicide

While there are ties between mental health and suicide, and mental health approaches remain necessary, they are not the only routes toward mitigation. An undivided fixation on specific mental health issues in suicide prevention can be misguided and ineffective. Nevertheless, in common understanding and mitigation efforts, suicide and mental health are often conjoined in an unbreakable manner, and as such, mitigation efforts lack diversity under the mental health context. For example, an overwhelming majority of suicide charities are centered on a mental health approach, and some of the most popular online communities can demonstrate this phenomenon. The With Hope Foundation is focused on “suicide prevention through improving mental health awareness.” At the same time, the Alliance of Hope Community Forum is a forum monitored by “Mental Health Professionals”, and the Morgan Meier foundation describes suicide as “the reaction of extremely intense feelings of loneliness, worthlessness, hopelessness, or depression” to name a few.

Of course, these approaches or claims are not wrong, but these approaches are limited. There is a stark over-fixation on mental health within these communities and little acknowledgment of more nuanced realities surrounding suicide and its prevention. In fact, for many mental health issues, there is a lower prevalence of suicide than accepted, with disorders like substance abuse, schizophrenia, and depression featuring a suicide risk assessment of around 5-8%. This finding, in contrast to an approach fixated on mental health alone, encourages a stress-diathesis model, which analyzes both individual disposition and environmental influence, suggesting that suicide is more multi-factorial than common perceptions around mental health suggest (Brådvik, 2018). Furthermore, in a study of suicidal ideation in psychiatric patients, researchers (Burgess & Hawton 1998) concluded that “the suicidal wishes of psychiatric patients are not always the result of an easily treatable and reversible mental illness or necessarily of any mental illness at all,” making clear that within these psychiatric patients, other factors influenced suicide to create a more nuanced basis for suicide prediction. Further studies (Brent et al., 1993), (Brent et al., 1993), discover a strong link between suicide and the presence of firearms, and highlight instances of suicide victims without psychiatric conditions, but who are most influenced in their decision to attempt suicide by the presence of firearms rather than mental illness. Therefore, while mental health remains a significant and robust connection with suicide, there remains space for analyzing other factors. This conception becomes especially apparent when constructing predictive and preventive measures, in which the connection between suicide and mental health has not been transferred, and the usage of mental health strategies lacks efficacy. This understanding leads us to the next major misconception.

We can best predict and mitigate suicide through psychiatric or mental health analysis alone

Since mental health is the primary fixation within the study of suicide, predictive and preventative measures are generally focused within the same context. This fixation can be seen through the statements of the organizations above and many organizations in general, in which mental health and the amelioration of mental health crises galvanize their efforts. These are sound efforts toward a broader attack on the suicide endemic. However, within the scope of predictive measures, which are necessary for ameliorating the suicide endemic, psychiatric and individual analysis, contrary to how they are commonly seen, are ineffective in predicting suicidal behaviors. In a meta-analysis of nearly three-hundred and sixty-five studies (Franklin et al., 2017), researchers found that predictive measures based on common risk factors (mental health issues, mental disorders, etc.) were only slightly better than chance for all outcomes and that no broad category could accurately predict far above chance levels. Furthermore, studies rarely examined the combined effect of multiple risk factors, and the researchers found that risk factors analyzing internal psychopathology accounted for a dominant 25% of all risk factor analyses. This led the researchers to suggest a multi-factor approach via algorithmic methods. As such, current single-factor prediction methods, structured mainly on mental health practices, are not effective alone, and there remains a necessity for multi-factor analysis to supersede a fixation on psychiatric analysis. Continuing, another study (Noch et al., 2022) analyzed clinician assessments, predicting one-month and six-month risk factors of a little over eighteen-hundred patients admitted to an emergency department, and found that clinician prediction was little better than chance at anticipating which of the patients would go on to attempt suicide within the time frame. It therefore becomes problematic to endorse mitigating efforts on the single factor analysis of individuals’ mental and psychiatric status, which has been fixated on in both research and shared understanding, and has distracted from other efforts through its sheer domination of the study of suicide. Instead, a multi-factored and open approach, acknowledging public and social causes of suicide, can be used in conjunction with preexisting strategies to access more immediate and attainable solutions.

Suicide is a problem tied to the individual

The effects of the various misconceptions above compound into a general focus on the individual, and the absolvement of the public, within a suicide endemic that can also be approached through a community lens but is often not. Risk factors, predictive measures, and treatment generally rely on individual examination and individualistic context. This focus manifests in focus on individual assessment and sometimes individual blame. Often, treatment and prediction efforts will include examinations of psychiatric conditions, recent life events, substance use habits, relationship happenings, job loss, family history, and more. On the other hand, aggregate suicide statistics, patterns, and trends indicate that suicide can be considered a public and social problem and can be mitigated as such. For example, per 2020 NCHS data briefs, stark disparities remained within suicide rates regarding demographic factors such as location and gender. Rural male suicide rates rose to 30.7 per 100,000 by 2018, while urban rates were at 21.5 per 100,000. Female rural and urban suicide rates reached 8.0 and 5.9 suicides per 100,000, respectively. As such, there remain significant social and demographic disparities within the suicide endemic along both geographical and gendered lines. Further, as a 2019 NCHS data brief highlighted, disparities exist along racial and ethnic lines. Suicide rates for American Indian and Alaskan Native populations (33.8 per 100,000 for men and 11.0 per woman), as well as for Whites (28.2 per 100,000 for men and 7.9 per woman), proved to be significantly higher than figures for other racial and ethnic populations such as Hispanic populations (11.2 per 100,000 for men, 2.6 for women) and African American populations (11.4 per 100,000 men, 2.8 for women). Another study ( Ellison et al., 1997) found a religious homogeneity index to be inversely related to suicide rates, while further studies (Baller & Richardson, 2002) found evidence suggesting that the geographical clustering of suicides in France and the United States was caused by the influence of both social integration and imitation factors. These studies support the understanding that suicide prevalence depends on compounding circumstances much more significant than just the individual, such as culture, social networks, access to means, environmental influence, geographical situation, gender socialization, and more. As such, there is strong evidence suggesting that suicide is influenced on a social and public level and can therefore be treated on a social and public basis. Furthermore, an over-fixation on an individualistic lens in the analysis and mitigation of suicide can be misguided, and distract from more attainable public solutions, such as the ones we will discuss below.

The Shortcomings of Current Mitigation Strategies

Introduction

The suicide endemic is growing, and current understandings and strategies, often solely fixated on individual analysis and ignorant of social and public factors, have not been practical enough. From 2000 to 2020, suicide rates in the United States rose nearly 30%, per the CDC. Not only have current mitigation efforts failed to minimize the existing suicide endemic, but they have also failed to prevent its growth; there remain difficulties that encumber mitigation efforts. Current strategies constructed on the common misconceptions outlined above are faced with mitigation difficulties that face these misconceptions. Furthermore, limitations of healthcare infrastructure within the privatized systems of the United States limit the efficacy of strategies solely based on the prediction and treatment of suicide through a psychiatric approach or the assessment of a mental health crisis. As such, on an aggregate level, the current, overly individualistic approach to suicide research, treatment, and prediction struggles to slow and reverse the suicide endemic due to difficulties we will discuss below.

Stigma

Despite the more than one thousand suicides at the Golden Gate Bridge since its opening, its only recently approved suicide barrier is yet to be completed. As mentioned in the expository New Yorker article ‘Jumpers,’ when a then engineer, Roger Grimes, protested along the Golden Gate Bridge in 1976 for the construction of a suicide barrier, his sign was met with flying soda cans and people telling him to jump himself, even in what can still be described as among the most progressive cities in our nation. Thus, the collection of misconceptions and the individualistic approach towards the suicide endemic produce a stigma that significantly impairs national mitigation efforts. As the British Journal of Psychiatry lamented, “the stigma around suicide remains just high enough to discourage people from discussing their suicidal thoughts” (Jadros & Jolley 2018). Ultimately, this runs in conjunction with the individualistic approach; when the roots of suicide are said to come from the individual, whether spoken or unspoken, the individual becomes partially culpable by societal standards.

Furthermore, alongside the discussion of suicide, moral weakness remains an understanding held by common thought, while individual pathology might be the equivalent in the more educated realms of research. Ultimately, stigma is harmful to the cultivation of public interest in mitigating suicide and treating suicide patients. In an analysis of public opinions, researchers have found the stigma toward Non-Suicidal Self Injury (NSSI) within sample populations to be significant to the extent that it may impact help-seeking behavior (Lloyd et al., 2018).

Furthermore, social acceptance of suicide is negatively correlated with suicide rates, in which nations and regions where suicidal behaviors are stigmatized have been found to maintain higher suicide rates (Schomerus et al., 2014). As such, the stigma around suicide is harmful to the broader treatment of the suicide endemic and is also largely present in our society. If mitigation efforts are to be reformed, public responsibility and involvement in the suicide endemic must be analyzed and accepted to relieve the blockading influence of stigma on the individual, and allow for the crafting of more immediate solutions.

Practical Inabilities

Alongside stigma, there remain practical limitations plaguing the current models and approaches to suicide. As outlined, beliefs that suicidal individuals often have a mental illness, engage in the process of deliberation, and progress through a state of inevitable deterioration do not run in conjunction with reality. As such, mitigating efforts that solely dedicate themselves to these conceptions, such as those focused on clinical prediction and analysis of the individual, have failed to prevent the growth of the suicide endemic. Practical limitations include the lack of preventative measures in the context of the rapid suicidal decision, the inability of physician-based prevention, and the ineffectiveness of general medical and clinical approaches toward the unique case of suicide. To start, the impulsive disposition of suicide, as discussed above, means that preventative measures would be most successful if focused on aiding the individual during crises rather than the more complex undertaking of ameliorating suicide in its early stages. Since, per the CDC, firearm deaths make up nearly half of all suicides, this could include reducing access to means in our social environment, like firearms, in order to block an individuals ability to attempt suicide while in a temporary crises. Currently, many preventative measures involve medical prediction that employs earlier mitigative strategies. However, as noted before, psychiatric practitioners are largely ineffective when asked to stretch their disciplinary limits and predict suicidal behaviors that are often the product of temporary crises. General practitioners prove to be similarly ineffective; Of 286 cases of suicide examined in a study (Pearson et al., 2009), 91% of individuals contacted their general practitioner within a year of committing suicide, but in only 27% of cases were concerns reported prior to the suicide, leading researchers to conclude that “Consultation prior to suicide is common but suicide prevention in primary care is challenging.” As such, while there remains a focus on psychiatric prevention of suicide, the medical professionals most often contacted by suicidal patients have not produced ameliorating results within the strategies of suicide prevention in the earlier stages. Continuing further, the use of psychiatric strategies (Mehlum et al., 2006) and psychological treatments (Brown, Jager-Hyman 2014), including therapy and pharmaceutical treatments, are either ineffective at mitigating suicide or in need of further improvement, leading further researchers (Large, 2018) to conclude that “Refraining from the temptation to predict suicide in clinical psychiatric practice might even assist suicide prevention.” In this sense, the commonly accepted notions of suicide and its prevention, including the processing of patients through routinized healthcare avenues, and mediums of individual prediction, consultation, and treatment, prove to be limited by a series of practical limitations that drawback to the realities behind the misunderstood suicide endemic. As researchers (Cole-King, Lepping) have enunciated, we need to ask ourselves ‘What can be done to prevent this person harming themselves today, this week, this month?” and move past the desire for an outright and clinical “cure” toward suicide when there are approachable and multidisciplinary methods available.

The Inadequacies of the Public Health Care System in Mitigating Suicide

Another, albeit less mentioned, question behind the mitigation of suicide through an individualistic and psychiatric lens would be our nation’s ability to provide widespread access to the clinical methods necessitated by such a model. Nearly one in every five (53 million) Americans suffer from varying mental illnesses. Nevertheless, studies analyzing the National Comorbidity Survey indicate that only 15.3% of respondents received minimally adequate treatment for severe mental illness (Wang et al., 2002). Meanwhile, in a report on suicide mitigation strategies, the CDC laments that “relatively few people in the US with mental health disorders receive treatment for those conditions.” Furthermore, a large proportion, two-thirds, of physicians reported that they could not get outpatient mental health care for patients, which is nearly two times that of other services, due to inadequate insurance coverage (Cunningham et al., 2009). As such, there remain healthcare and insurance barriers to providing mental health care at a rate that current strategies necessitate. Even further, in an aggregate analysis, our current healthcare system, even if made available to all, may not have the capabilities to combat a national mental health crisis; over 155 million Americans, often in low-income communities, live in Health Professional Shortage Areas (HPSAs), or areas with inadequate mental health infrastructure and capabilities. It seems unfortunately and unjustly predictable that treatments would tend not to reach those of lower socio-economic status, especially in our privatized healthcare system, but even more jarring is the fact that treatments are not reaching the severely mentally ill patients who would be at the highest risk for suicide. These are two glaring wrongdoings within the broader incapabilities of our healthcare system and its necessity for suicide prevention. Therefore, if current strategies necessitate large-scale mitigation of the suicide endemic through a parallel, clinical movement against the mental health crises, they remain hindered by our inability, through coverage and healthcare delivery difficulties, to provide access to clinical treatment and prevention of suicide for all. This understanding further necessitates the need for more diverse and attainable prevention methods outside of the current model.

Immediate and Practical Prevention Methods

Introduction

We live in a society with several complex social problems, but suicide does not have to be one. There are many attainable and immediate ways to prevent and mitigate suicide and circumvent the debilitating circumstances around the suicide endemic. In this paper, we have discussed the presence of a harmful over-fixation on individualistic, psychiatric approaches to suicide mitigation; however, through a public and social lens, we can create a multidisciplinary approach and achieve more immediate gains in suicide mitigation. Continuing on the theme of public responsibility, we will discuss the following immediate and practical solutions toward suicide mitigation that move past the individualistic view and incorporate the realities behind the suicide endemic.

Reducing Means Toward Suicide

To most immediately combat the suicide endemic, restricting means remains the most viable pathway. This strategy aligns with the argument we have laid out; if suicides come at impulsive moments of vulnerability, and are unlikely to be followed by further attempts, then restricting an individual’s ability to attempt or complete suicide on hand becomes incredibly important to mitigative efforts. Most importantly, limiting access to firearms, which prove to be tools of no return, would prove the most effective policy for reducing suicide rates. Of all suicides in 2020, nearly 53 % involved a firearm (CDC). Furthermore, of all suicide methods, firearms remain the most lethal, at around an 83% fatality rate as opposed to lower rates for suffocation/hanging (61.4%) and significantly lower rates for Poisoning (1.5%) and cutting/piercing (1.2%), which represent the other most common means toward suicide (Spicer & Miller, 2000). Continuing, several studies show that the presence of firearms can have an inflating effect on suicide rates; in case-control studies, guns were twice as likely to be found in the homes of those who had made fatal attempts (Brent et al., 1991), and further research finds that the relationship between suicide and the presence of any firearm within a household are significant (Brent et al., 1993). On an aggregate level, regions of the United States with high gun ownership were found to possess suicide rates nearly 14% higher than regions with low gun ownership (Miller et al., 2002), while studies controlling for regional culture variation found that short-term exposure or visiting regions with high gun ownership, by outside residents, was found to have a positive effect on suicide rates (Shrira & Christenfield, 2010). As such, we know that guns have a significant, and potentially causal, effect on suicide on an individual and aggregate level— as the Harvard School of Public Health states, “Every study that has examined the issue to date has found that within the US, access to firearms is associated with increased suicide risk.” In regards to the progression from restricted methods to available methods, it has been further demonstrated that many individuals will not progress past or substitute their favored method, which often exists, if they find it restricted (Hawton, 2007). Furthermore, it is known that restriction of means has proven successful at reducing suicide rates in the past; suicide rates fell with the restriction of access to carbon-monoxide methods via charcoal in Hong Kong (Yip et al., 2010), regulation of lethal pesticides often used in Sri Lanka (Gunnell et al., 2007), and the decades’ long progression from monoxide usage in domestic gas in the United Kingdom (Kreitman, 1976). The restriction of means, mainly firearms, remains a necessary strategy in suicide prevention through both quantitative and qualitative understandings of suicide. If our nation is willing to reduce means, such as by taking steps to reduce firearm access or building suicide barriers in places like the Golden Gate Bridge, it can incorporate an understanding of the public power and responsibility within the suicide endemic. Its subsequent recognition of suicide means can be an effective preventative strategy, which accepts the overwhelming numerical and contextual evidence toward a more holistic approach regarding suicide prevention.

Optimizing Media Output and Suicide Contagion

Media reporting on suicide has been demonstrated to strongly correlate with suicide rates. As such, the optimization of media output concerning suicide contagion is necessary. Generally, suicide contagion can be understood within social learning theory, in which individuals are influenced by imitation effects and social tides larger than themselves, and can produce suicide clusters as a result. In this sense, regulating media output can be a powerful mitigative tool. In a 1979 study, to be followed by further studies (Kuezz et al., 1986), (Michel et al., 1995), Dr. David D. Phillips found a positive correlation between front-page or marked reporting styles of suicide and an increase in suicide rates, an effect he dubbed the “The Werther Effect” (Phillips, 1974). The Werther Effect remains the basis for suicide contagion theories and can be accessed for mitigative strategies. Meanwhile, in an international comparative study, nations where suicide is reported in a more discouraging light (The United States, Finland, and Germany), have been found to have lower suicide rates than nations that portray suicide in a more open light (Hungary and Japan) (Fekete et al., 2001). Furthermore, researchers (Niederkrotenthaler et al., 2010) have found that repetitive reporting of suicides and suicide myths also correlates with increased rates, while reporting of suicidal thoughts that are not followed by a suicide attempt correlates with decreased rates. Therefore, there remains an influence of media reporting on suicide contagion, but there is further evidence supporting the fact that reporting guidelines can prove beneficial. During a spike in suicide attempts on Viennese subways in the 1980s, the implementation of media reporting guidelines and restrictions proved successful at reducing subway suicides by nearly 75% over several years (Sonneck et al., 1994). In the opposite fashion, when California Highway Patrol and local newspapers used to keep a running suicide count for the Golden Gate Bridge, landmark numbers like 500 and 1000 were met with cases of suicide frenzy. As a result, many organizations, including charities and the CDC, have offered guidelines for newspapers and media corporations to use to aid media regulations. Nevertheless, in a study analyzing the acceptance of basic guidelines set forth by the Samaritans, an organization from the UK that deals with mental health and suicide, it was deduced that 199 of the 229 articles examined failed to comply with one of the said guidelines, such as mentioning support sources or avoiding excessive or influencing details (Utterson et al., 2017). Thus there remains room for improvement within the reporting of suicide. Media reporting has been demonstrated to positively and negatively influence suicide rates, depending on how it is displayed. The narrative surrounding individuals within our societies can influence their suicidal vulnerability. Therefore, we must accept the public responsibility of establishing proper reporting and journalistic guidelines, via the acceptance of suggestions put forth by knowledgable organizations, to combat another of the many social influences on suicide effectively.

Creating More Standardized Data Collection and Classification Methods

Another difficulty that plagues suicide mitigation efforts is the struggle that our society experiences in tracking and classifying suicide cases. If suicide efforts are to be adequately addressed and organized, data sets behind suicide research, and further action, must be accurate and standardized. Lack of resources, lack of information, communal stigmas, ambiguous classification systems, and the perplexing nature of suicide are all barriers that can hamper the classification of individual suicides and create inaccuracies in aggregate measures of suicide. (Silverman, 2016) captures the difficulties of suicide classification systems in the face of widespread moral and procedural ambiguity in the field of suicidology. Meanwhile, on an aggregate level, African American and Hispanic suicide rates have been found to experience excessive rates of suicide misclassification due to cultural differences in classification, explaining the misleading gap in White and African American suicide rates ( Wang et al., 2010). In the past, studies have indicated a social construction of suicide rates and a range of misclassification. (Pescolindo & Mendelsohn, 1986) Highlighted the influence on suicide rates by the social organizations or groups tasked with counting them and the presence of widespread and consistent miscalculation at the hands of responsible agencies. Furthermore, (Douglas, 1967) demonstrated the principle that suicide rates are often constructed by external social factors, while statistics experience widespread error as a result. For example, From 1985 to 1989, suicide rates in New York City fell substantially due to policy changes in the New York City Chief Medical Examiner’s Office, which was engaging in preservative practices in the face of backlash and criticism at the time (Witt, 2006). These shifts affected efforts to measure or quantify suicide behavior or approach mitigating strategies, and demonstrate the malleability of suicide statistics in the face of broader social movements. As such, even the most advanced nations struggle to compose suicide statistics. To better understand or approach the suicide endemic, we must accept standard approaches to classification and provide practitioners with the resources to properly examine cases of suicide. It is imperative to construct an objective classification and nomenclature system, which currently does not exist, that can avoid the variation present in suicide classification systems.

Reform of Cultural Influences Behind Suicide Ignorance:

Everything from the language we use to the narratives we create can impact our ability to mitigate suicide rates in the United States. In an expressly individualistic culture, our understanding of and interactions with suicide can become harmful. As we have seen earlier, there are many specific misconceptions surrounding suicide, but our society also engages in broader malpractice as a whole. The obsessive individualism that the United States has grown around makes it almost inevitable for our strategies against suicide to be so focused on the individual and mental health strategies. As such, the difficulty of releasing this rugged individuality disposes us to focus our efforts on the individual’s well-being, not the communities and demographics that encircle them. Much in the American tradition, each individual is seen as a carrier of their outcome, and each instance of suicide is seen as its outlying case. Whether spoken or unspoken, individuals are cast off, blamed even, for what is seen as a pathology of their mind or weakness of their disposition. Because social solutions do not fall within the cultural paradigm of individuality, they are often displaced by a hyper-fixation on the individual, which does run in conjunction with our societal values. Nevertheless, as we have argued, suicide is as much an affliction of the individual as it is a social failure, and suicide is a unique tragedy that the United States cannot force its cultural values upon. If we can find the humility to deviate from our cultural values when approaching its suicide endemic, we can more effectively combat a social issue of our time. We could do this by providing social support, easy access to crisis management, restricting suicide means, creating more accepting discussions on suicide, and more. However, while there are many solutions available, to approach them or move on to the solutions we have highlighted in this paper, we must start by reforming our nation’s thoughts on the individual and suicide. We must absolve the individual of its scrutiny in the suicide endemic and move past our cultural beliefs to craft a more knowledgeable and viable strategy against suicide.

Conclusion

The suicide endemic and our efforts to mitigate it remain oriented around individuals and individual-level approaches. Moving forward, we must first adjust and update our understanding of the suicide endemic; contrary to the individualistic fixation on mental health, the individual is not culpable in the broader social patterns that influence their propensity for suicide, and current approaches reveal how suicides are regulalrly misunderstood. Our current mitigation strategies, bogged down by practical limitations and stigma, must be reformed to accept the broader social responsibility and act accordingly by accessing strategies that challenge the current methods. We can do this by accepting the realities and strategies we have displayed behind our theme of societal solutions. If we broaden our view of suicide and its mitigation, we can approach a public health issue that has too often been considered intractable, and make progress towards reform and change. In this sense, we can persevere in the face of what might feel like an overwhelming number of social problems today.

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About the author

Victor Josifovski

Victor is a senior at Los Gatos High School. He is a huge history buff, and enjoys reading, everything from Orwell, to Hemingway, to Dostoevsky. Victor also enjoys playing basketball, both through clubs and his school team. He coaches youth sports in his free time.

The post Suicide Mitigation: Moving from an Individualistic Lens to a Collective Analysis in Preventing Suicides appeared first on Exploratio Journal.

Abstract

Migraine is the sixth most disabling illness in the world and the third most common (Saper, 2021). Many studies have found that migraines have numerous causes, which creates a wide variability in the effectiveness of treatments. In recent years, there has been exploration of alternative methods of treatment, such as music therapy. There have been many studies regarding music therapy and pain treatment, but very few specifically for headaches, and results have been inconclusive. The proposed research seeks to examine the extent to which predisposed beliefs about music therapy impact its efficacy when treating chronic migraines. Over the course of a six-week study, patients will be randomly assigned to one of two experimental treatment conditions whereby they will receive a combination or standard pharmaceutical treatment plus music therapy or standard pharmaceutical treatment plus therapeutic rhythmic class. Patients will also report the degree to which they perceive music therapy and other alternative treatments as effective pain-relieving measures. Patients will also report their pain symptoms weekly. It is anticipated that patients with stronger belief in the efficacy of music therapy, in particular, will experience greater reduction in pain symptoms when in the music therapy condition. The implications of an interaction between treatment efficacy beliefs and actual treatment effectiveness are discussed.

The Impact of Belief in Treatment Methodology on the Efficacy of Music Therapy in Those with Chronic Migraines

While many people have friends or family members who suffer from migraines, individuals who do not experience migraines themselves may be unaware of how chronic, unpredictable, and often mysterious migraine symptoms are. Approximately 1 billion people around the world have migraines (Pool, 2021), making migraines the third most prevalent illness in the world, along with being the 6th most disabling (Saper, 2021). Lipton et al. (2007) reported that 53.7% of those with migraines were severely impaired.  Munakata et al. (2009) found that those with episodic migraine had direct and indirect costs of $1757 per year, and those with transformed migraine had costs of $7750 per year.  Those who experience migraine–as well as their closest family and friends–are more likely to pursue knowledge regarding migraine causes and treatment (Saper, 2021), but they often find that migraines have many different causes and thus there is wide variability in types of treatment and their efficacy (Dodick & Gargus, 2008). Recently, there has been increasing interest in alternative treatments for migraine sufferers such as yoga (John et. al, 2007), risk factor modification (Schwedt, 2014), and music therapy (Diamante & Roxas, 2020). However, the degree to which such alternative treatments alleviate symptoms may be influenced by patients’ beliefs in their efficacy (e.g., Horne, 1999). Accordingly, the current research proposal seeks to examine how much predisposed beliefs about music therapy impact its efficacy, and if music therapy is actually effective in treating chronic migraines.

Music Therapy

Music therapy has been examined as a potential treatment for dementia (Vink et. al, 2003), generalized anxiety disorder (Gutiérrez & Camarena, 2015), as well as chronic migraine symptoms (Diamante & Roxas, 2020). Research on the use of music therapy as a treatment for migraines has demonstrated that it shows a significant improvement from no treatment (Oelkers-Ax, 2008). Music therapy has been shown to be effective for those seeking treatment for chronic migraine and tinnitus (Nickel et al., 2005). Additionally, Langenburg and colleagues (1995) did a case study on music therapy as treatment for someone with chronic migraines which demonstrated that it does lessen migraine symptoms. While additional studies have demonstrated similar efficacy for MT as a treatment for migraines (e.g., Diamante & Roxas, 2020), other studies have found that MT, while effective, is no more effective than other alternative treatments (Koenig, 2014). Moreover, music therapy can better improve executive functioning when it is able to provide functional support (Thaut & Hoemberg, 2017). Accordingly, we should expect music therapy to reduce migraine symptoms in patients when used in conjunction with standard treatment, but perhaps not more so than other distracting treatments. However, there are moderating factors that could influence the degree to which individual patients respond to alternative treatments such as music therapy–one of which may be their belief in the efficacy of music therapy.

Patient’s Beliefs in the Efficacy of Treatment

The ability of a patient’s belief in the efficacy of certain treatments to affect treatment outcomes has been examined in a variety of contexts. Patients’ beliefs about the type of treatment they’re receiving has been shown to impact the efficacy of that treatment (Horne, 1999). The symptoms of patients suffering from various illnesses were shown to respond more strongly to medical treatment among patients who believe more strongly in the effectiveness of traditional medicine as a treatment (Foulks et. al, 1986): the expectation of a drug’s impact on symptoms strongly influences the therapeutic efficacy of that drug (Bingel et al, 2011). Similarly, Clatworthy et. al found that patients better adhered to their treatment plan when they believed that it would work, and thus they found more benefits from their treatment (2007). In addition, a study regarding the effects of methotrexate on rheumatoid arthritis symptoms found similar results (de Thurah et. al, 2009). Studies have also demonstrated that beliefs regarding severity of the patient’s illness impact the efficacy of the treatment (Marks et al., 1986). However, to the best of our knowledge, no research has yet investigated this moderating influence regarding the efficacy of music therapy in migraine treatment. Accordingly, the current research will assign patients to two conditions of music therapy, one who has strong beliefs in the efficacy of music therapy, and one who does not. These two groups will demonstrate the relationship between belief in the efficacy of treatment and pain reduction.

Research Hypothesis: We expect that the efficacy of music therapy, in comparison to a different alternative treatment, in reducing migraine symptoms will be moderated by patients’ beliefs in music therapy’s effectiveness. Specifically, we expect that the relative efficacy of music therapy, in comparison to yoga therapy, in relieving chronic pain symptoms will be greater among individuals who already perceive music therapy as an effective treatment.

Method

Participants

Participants will be recruited from a hospital circuit, through compliant doctors asking their patients with chronic migraines. They will be given a small monetary sum, and the study will be conducted in an academic center with music facilities.  

Measures

Belief in Treatment Efficacy. Prior to being randomly assigned to a treatment condition, patients will fill out a brief survey asking them to report how effective they believe each of the following therapies would be for reducing their migraine symptoms: music therapy, rhythmic class, yoga, mindfulness meditation, traditional western medicine, and pet therapy (Appendix A). Brief descriptions of each therapy type will accompany the items. Participants will indicate their belief in the efficacy of each therapy on a 1 (“Not at All Effective”) to 7 (“Highly Effective”) Likert-type scale. The variable of interest is patients’ beliefs in the efficacy of music therapy, and patients will be told that their beliefs will not affect the treatment condition to which they are assigned. 

Treatment Condition. Patients will be randomly assigned to receive one of two treatments in addition to traditional pharmaceutical treatment: music therapy or rhythmic class This treatment manipulation is similar to one used in previous research (Gutgsell et. al 2013).  In each condition, patients will undergo their additional treatment 3 times per week. Patients in the music therapy condition will go into a dark room without distractions for 20 minutes and have a music therapist play harp pieces for them. Patients in the rhythmic class (Bozorg-Nejad et. al 2018) condition will go into a dark room without distractions for 20 minutes and will be taught how to control the various paces of the body with breathing. These conditions will last for 6 weeks.

Improvement of Symptoms. The dependent variable that will be measured is the difference in pain before treatment and after treatment using a standardized scale. Patients will rate their overall severity of their symptoms at the end of each week on a scale from 0 (“No Symptoms”) to 10 (“Emergency Treatment Necessary”) similar to measures of migraine pain used in previous research (Jensen et. al 1999). Average scores from the final three weeks will be subtracted from average scores from the first three weeks to determine the change in symptoms over the treatment period.

Procedure

 When first agreeing to participate in the study, the participants will complete an informed consent document. They will be given their monetary reimbursement of $50 for their time, and then will be separated into two groups, after being sent and completing the survey about their beliefs in the efficacy of music therapy remotely. From those two groups they will be randomly assigned to either the music therapy condition or the rhythmic class, depending on what time of day they fill out the survey. They will then go to these therapies at least three times per week for 20 minutes for six weeks. Over the course of these six weeks their pain symptoms will be monitored and recorded through their respective nurses on the standardized scale in Appendix B. 

Results

Correlational Analyses

A zero-order Pearson correlational analysis will be conducted to assess the relationship between belief in the efficacy of music therapy and improvement of pain symptoms for patients in the MT condition only. We hypothesize that, among patients in the MT condition, higher belief in MT will predict more improvement of symptoms. We expect to see a similar correlation between belief in the effectiveness of rhythmic class in the comparison condition.

T-Test

A t-test will be conducted to compare symptom improvement between the two experimental groups. We expect that without taking into account the patients’ beliefs in MT’s effectiveness that patients in the MT conditional will not show significantly more or less improvement than patients in the rhythmic class condition. 

 Moderation Analysis

To test our primary research hypothesis, a moderation analysis will be conducted using the PROCESS macro (Hayes, 2013) Model 1. Treatment condition will be added to the model as the independent variable (x), belief in the efficacy of music therapy as the moderator (w), and symptom improvement as the dependent variable (y). We predict that belief in the efficacy of MT will moderate the difference between treatment groups such that MT will be more effective than rhythmic class among participants with higher beliefs in MT’s efficacy. The conceptual model is illustrated in Figure 1.

Discussion

The proposed study seeks to explore the relationship between patients’ beliefs in the efficacy of alternative forms of treatment for chronic pain and the actual effectiveness of those treatments. In particular, this study intends to focus on music therapy (MT) as a potential treatment. Patients’ beliefs about MT, and other alternative treatments, will be measured prior to random assignment to a treatment condition that includes typical pharmaceutical treatment plus either music therapy or a comparison treatments condition. It is hypothesized that beliefs in the efficacy of MT will interact with assignment to the MT condition such that patients who perceive MT as more effective and are assigned to the MT condition will experience more pain symptom relief over the course of the study. 

Implications

Approximately 5-12% percent of people worldwide suffer from migraines (MacGregor et. al, 2003), which is millions of people. Therefore, the majority of people at least know someone who is a victim of this kind of pain. Additionally, making strides within the treatment of these migraines could vastly improve quality of life. Music therapy specifically is an instance of alternative methods, based on other facts. If the experimental hypothesis was supported, then pain treatment would be reimagined to adjust to the beliefs of the patient. To ensure the best outcomes, physicians could prescribe whichever alternative treatment an individual patient has the most positive views of in addition to pharmaceutical treatment. Additionally, results that support our hypotheses would suggest that physicians should emphasize scientific support for alternative methods to their patients. Doing so may make beliefs about such treatments more positive, which would in turn make the treatments more effective.

Limitations

This study would be done on adults, so it probably would not be as conclusive for the same study done on children or adolescents. The proposed study also does not account for potential disparities among those who have chronic migraines. This study also would not discuss the musical aspect involved in rhythm. The proposed study also does not account for the influence of those providing the treatment on the patient’s belief in efficacy. This study also only compares two types of alternative therapies, when there are many others which could have different results.

Future Directions

In future studies, there should be much deliberation regarding the control therapy and how it relates to music therapy. There could be focus on how different types of music impact the efficacy, or how it relates to what is being treated. . For instance, it has been shown that music can help those with dementia express themselves with language (Brotons & Kroger, 2000). Moreover, connecting these two things is something worth looking into, based on how music has a unique impact on the brain and has helped lessen the impacts of other neurological disorders. As far as pain management goes, it is important to consider the different ways that people can feel pain and how each experience it unique, along with the wide variety of treatment methods- beyond the ones discussed in this proposal.

References

Bingel, U., Wanigasekera, V., Wiech, K., Mhuircheartaigh, R. N., Lee, M. C., Ploner, M., & Tracey, I. (2011). The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Science translational medicine, 3(70), 70ra14-70ra14.

Bozorg-Nejad, M., Azizkhani, H., Ardebili, F. M., Mousavi, S. K., Manafi, F., & Hosseini, A. F. (2018). The effect of rhythmic breathing on pain of dressing change in patients with burns referred to ayatollah mousavi hospital. World journal of plastic surgery, 7(1), 51.

Brotons, M., PhD, MT-BC, Koger, S. PhD, The Impact of Music Therapy on Language Functioning in Dementia, Journal of Music Therapy, Volume 37, Issue 3, Fall 2000, Pages 183–195, https://doi.org/10.1093/jmt/37.3.183

Clatworthy, J., Bowskill, R., Rank, T., Parham, R., & Horne, R. (2007). Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients’ beliefs about the condition and its treatment. Bipolar disorders, 9(6), 656-664.

de Thurah, A., Nørgaard, M., Harder, I. et al. Compliance with methotrexate treatment in patients with rheumatoid arthritis: influence of patients’ beliefs about the medicine. A prospective cohort study. Rheumatol Int 30, 1441–1448 (2010). https://doi.org/10.1007/s00296-009-1160-8

Foulks, E. F., Persons, J. B., & Merkel, R. L. (1986). The effect of patients’ beliefs about their illnesses on compliance in psychotherapy. The American Journal of Psychiatry, 143(3), 340–344. https://doi.org/10.1176/ajp.143.3.340

Gutiérrez, E. O. F., & Camarena, V. A. T. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy, 44, 19-24. 

Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris, M., … & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a randomized controlled trial. Journal of pain and symptom management, 45(5), 822-831.

Horne, R. (1999). Patients’ beliefs about treatment: The hidden determinant of treatment outcome?[Editorial]. Journal of Psychosomatic Research, 47(6), 491–495. https://doi.org/10.1016/S0022-3999(99)00058-6

Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D. (1999). Comparative reliability and validity of chronic pain intensity measures. Pain, 83(2), 157-162.

John, P., Sharma, N., Sharma, C.M. and Kankane, A. (2007), Effectiveness of Yoga Therapy in the Treatment of Migraine Without Aura: A Randomized Controlled Trial. Headache: The Journal of Head and Face Pain, 47: 654-661

Koenig J. Music therapy in the treatment of primary headache disorders. OA Alternative Medicine 2014 Jan 18;2(1):1

Langenberg, M., Frommer, J., & Tress, W. (1995). Music therapy single case research–a qualitative approach. Psychotherapie, Psychosomatik, medizinische Psychologie, 45(12), 418-426.

MacGregor, E. A., Brandes, J., & Eikermann, A. (2003). Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. Headache: The Journal of Head and Face Pain, 43(1), 19-26.

Lipton, R. B., Bigal, M. E., Diamond, M., Freitag, F., Reed, M. L., & Stewart, W. F. (2007). Migraine prevalence, disease burden, and the need for preventive therapy. Neurology, 68(5), 343-349.

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Appendix A

Questionnaire for measuring belief in efficacy of music therapy.

How confident are you in the ability of pet therapy to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of rhythmic classes to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of yoga to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of music therapy to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of traditional western medicine to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of mindfulness meditation to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

Appendix B

Measurement of pain

How would you rate your pain symptoms this week??

  1               2              3                 4              5              6              7                8               9            10

No symptoms                                                                                                                                                                                                                                                                                                    

About the author

Karishma Kulshrestha

Karishma is currently a Senior at the Thomas Worthington High School in Ohio. She has a strong passion for people, and her extraverted nature is where this seed was planted. As someone with chronic migraines herself, she has seen a lot of the medical systems from the patient perspective which has allowed her to think about things others might not normally. Karishma is in marching band and was a drum major this year. She also plays volleyball, and started a ski club at her school.

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“I think I have OCD because I want everything to be neat.”

Obsessive-Compulsive Disorder is one of the most well-known mental illnesses. However, it’s also one of the most misunderstood. Often when someone says, “I think I have OCD,” they’re referring to the fact that they always like to keep things organized. This, however, is not true. OCD symptoms consist of obsessing over the tiniest things. The obsession leads to constant anxiety and crushing stress. It’s not just someone wanting everything to be neat. People with OCD face repeated intrusive thoughts that mix with fear or danger. [1]

The fear that envelopes those with OCD can materialize as a need for symmetrical arrangement, although everyone’s symptoms differ based on their doubts in themselves and other internalized concerns. People who genuinely have OCD do not simply engage in excessively detailed practices because they feel like it. They constantly have these compulsions because of the anxiety that’s weighing on them; for example, the constant need to check on their family members or loved ones to make sure that they’re safe. [2]

According to www.helpguide.org, the cycle of OCD includes 1; an obsessive thought taking over someone’s mind. 2; the anxiety that comes along with not being able to control the thought. 3; compulsive behaviors such as repeatedly tapping or touching an object. 4; the temporary relief. Upon reaching the final step, the cycle starts again. These continued thoughts are what makes OCD such a severe illness and not something to joke about. [2] Patients who have it describe it as a ‘mental discomfort’ that leads to anxiety and fear. [5]

Simply because someone prefers everything to be neat does not mean that they have OCD. This common misconception can lead to others believing that this illness is not as severe and profound as it truly is. Bystanders will think that it is okay to use the term “OCD” lightly. 

When people see the symptoms and effects of OCD, they start to say things such as, “calm down, nothing bad will happen,” or, “the stove is off, don’t recheck it, it’s fine.” [3]However, for someone who truly suffers from OCD, these obsessions cannot just be cured by “calming down.” This is a severe chronic illness that deserves more attention. These obsessions and compulsions are almost outright impossible to control without medical help. [3] The thought itself is caused by a disturbance between the frontal cortex of one’s brain and the ventral striatum. Patients cannot just “calm down” when in the cycle of OCD because it is near impossible to control their anxiety. [4]

My research aims to identify the frequency of misinterpretation of OCD as well as the adverse effects that such misinterpretation may cause on those who have OCD. My study analyzes existing data on the prevalence of OCD, including self-developed surveys of individuals with and without OCD.

How OCD is Mischaracterized

Having OCD misinterpreted is extremely disrespectful to actual patients suffering from the disorder. Over 1 percent of Americans suffer from OCD. [6] Yet around 66% of Americans say that a dirty home makes them feel anxious.[7] These two types of anxiety are completely different. While OCD is a serious mental illness affecting 2.2 million Americans, feeling anxious about a dirty home is a common anxiety shared among over half of the population. There are so many people among these patients who hide their symptoms from embarrassment or fear. [8] Joking about OCD is extremely disrespectful and embarrassing to those who suffer from the illness. Saying “I’m so OCD” can blur the line between a devastating disorder and a regular need for neatness. People are stripping the illness of its severity, and this also applies to any illness. This can make it extremely hard for people to seek help. [9]

Making light of this extremely serious mental illness is not only insensitive, but extremely detrimental to a patient. Those with OCD might feel as though their very real symptoms and obsessions aren’t as important, leading them to avoid seeking help. Making a joke of OCD, or saying that one has it is making fun of an extremely tortuous routine that patients have to go through daily. Those who mischaracterize OCD are contributing to the stigma that has made many patients hide their illness for years and years. People are joking about patients who have to go through exhausting rituals as well as intrusive thoughts just to sound “quirky and different.” [8]

There are multiple scenarios where people mischaracterize OCD. The seven main ones include: Keeping a tidy living space, worrying about an upcoming event, wanting to arrive somewhere early, being a “perfectionist,” wanting to wash one’s hands, hanging onto things one doesn’t use anymore, and finally checking and then double-checking things. [10] Each of these examples are common anxieties among people who don’t have OCD. All of these things might annoy or bug someone, but it’s not to the extent of OCD, and it doesn’t have as negative of an impact on people, says a licensed psychologist Dr. Crystal I. Lee. [10]

A lot of things that annoy the usual person doesn’t affect them the same way as an obsession would affect a patient with OCD. OCD is much more extreme and it takes up so much more time in a patient’s life. The reason why OCD is so mischaracterized is because of the lack of education. Most people don’t easily come across information on certain illnesses because it doesn’t affect them, and they don’t search it up. OCD is also extremely misportrayed in the media. There’s a false representation of the mental illness. It’s usually represented mainly around a fear of germs and cleaning compulsions. When the majority of people look at the media and see this, it doesn’t give a clear picture of OCD. They feel like OCD is just what the media portrays it as. [11]

What It Truly Means to Have OCD

Charlotte, an anonymous contributor to the mental health awareness website www.mind.org, says OCD is like a constant fear of not being able to complete something the right way. She lives with obsessions taking over her thoughts daily. He also has rituals to get rid of those obsessions, which are called compulsions. She says that these compulsions are extremely horrific, especially because she has these thoughts on a daily basis. [12] Imagine having unwanted thoughts up to 20 times a day, and not being able to get rid of them. 

Mark Highet, a father and public servant from Queensland, Australia, says that even everyday actions like turning on a light switch can trigger his OCD. This can lead to anxiety, causing him to do rituals in order to forget about the obsessions. “For example, one day I was filling up my daughter’s water bottle,” he says, “and I had the thought that the water might be contaminated. I rationally knew it wasn’t, but I had this worry. So, I turned back to the sink, tipped it out and filled it again. I went to give it to her, but then I worried again, so I tipped it back out. I must have done it 40 times.” Mark goes on to say that it almost feels humiliating when someone from work sees him doing a ritual. He says that it feels like he’s so busy trying to live, that he’s forgetting to live. [13]

OCD isn’t just wanting everything to be neat. It’s about spending minutes to hours of one’s day trying to get rid of a thought that’s taking over one’s mind. For some, it might be “if I don’t do this, my family is going to get hurt.”[9] For others, it might be “If I turn something on, I might not be able to turn it off.” [13] These thoughts cause extreme and heavy anxiety among patients who have OCD. It can cause them to fear for their loved ones, because they think that they’ll end up hurting someone close to them. These thoughts aren’t just shallow little ‘what ifs.’ They are thoughts that can significantly impact a person’s life. It’s extremely complex, far past the point of wanting everything to be perfect. OCD can cause an overload of function systems in one’s brain. [14]

Having a constant obsession on one’s mind can lead to rituals. Rituals are an action that a patient performs when they try to forget about the obsession taking over their mind. For example, performing a repetitive activity, like locking, unlocking, and relocking a door. These rituals are usually performed physically to get rid of the muscle tension coming from obsessive thoughts. Rituals are usually described as mental and physical exercises that people with OCD perform to get rid of feelings such as disgust or anxiety. Rituals can also be performed to prevent a dangerous situation. People with OCD often can’t suppress their thoughts, which is why they cope through performing rituals. [15] Hattie Gladwell from metro.co.uk says that OCD takes up around 14 hours of her week every single week. [16] That’s over 8% of her entire week. These rituals aren’t actions that can be done only one or two times and solved. Patients spend hours and hours trying to get rid of their obsessions. 

Dangers of Mischaracterization

Charlotte at Mind.org also mentions, “anyone who says that having OCD is ‘helpful’ couldn’t be further from the truth. I may spend hours cleaning dishes and making sure my things are organised/symmetrical – but when will any of these compulsions benefit me? NEVER.” [12] Saying that OCD is beneficial to patients is disrespectful in and of itself because one is making a really serious mental illness seem like it’s benefiting a patient, even if in reality, it’s hurting them. 

Mark Highet has experienced jokes about OCD firsthand. He says, “At my work we have a regular meeting, where everyone goes around the table and updates on how they’re going. One day, one of my co-workers said, ‘Oh sorry, that’s so OCD of me,’ when she finished her bit. When I hear that, I think, ‘if only you knew.’ It’s a real, and really hard, condition.” Jokes like this can increase the stigma around OCD itself, which is harmful to people who are seeking help. It’s a real mental health issue, and no laughing matter. Michelle Blanchard says that “OCD is often appropriated as a casual term but trivialising it only adds to the stigma that often prevents people from seeking help.” [13]

Serena Ata from the website inkspire.org says that she wasn’t able to fully diagnose her OCD because of the stigma around the disorder. All of her symptoms were viewed as “normal” because people said that all her compulsions were things that she would grow out of. Serena says that making jokes about OCD is extremely damaging to patients who suffer from the  disorder. For her, she had to spend years scrolling through the internet to try and find an answer and a reason as to why she was spending hours of her week on rituals. “Unfortunately, many sufferers find themselves dependent on unreliable platforms for answers, often leading to a vicious cycle of misinformation, misunderstanding and misdirection.” [17]

It can take up to 17 years on average for people to receive an OCD diagnosis. [18] Only about 200,000 people with OCD seek therapy out of the 4.1 million people who need the treatment. [19] When patients view the media and see OCD being portrayed as a simple little quirk, they won’t seek out help, and they won’t try to get treatment. Patients would feel like their symptoms are normal, and they put it aside. Mischaracterizing OCD can lead to actual patients taking years and years to seek the treatment that they actually need. This can harm the patients themselves, because OCD symptoms can progressively get more intense. OCD symptoms get worse with age, so when patients don’t seek help at a young age, it would be harder for them to deal with it. [20]

Conclusion and Further Guidance

Mischaracterizing OCD can lead to patients not getting correct treatment, and patients feeling like their mental illness isn’t actually serious. It harms the OCD community by joking about a mental illness that’s extremely legitimate. Mischaracterizing OCD can also add to the stigma around the topic. When the media portrays OCD as something light and fun, it can lead to patients feeling like their symptoms aren’t important, even though they are. If any individuals have ever made a joke about OCD or have mischaracterized OCD, they should do their best to educate themselves on the topic. One should start to take this disorder more seriously from now on, and do one’s best to support patients with OCD as best as they can.

If someone knows a family member or friend who has OCD, the Victoria State Government Department of Health recommends that one should first make sure to educate themselves on their family member’s disorder. When people have connections with patients, it can ease the tension around their relationship. When they’re performing a ritual, one shouldn’t participate in the rituals themselves, because it could reinforce OCD behaviour and it could lead to symptoms potentially getting worse. [21] Though one shouldn’t assist them in the rituals themselves, they should remind them that it shouldn’t be something that they’re embarrassed about. They should make sure that they’re getting the right treatment like professional help. 

In the event that a patient starts to lose motivation in seeking help, close relatives and friends should continue supporting them. If they start to have less motivation to go get treatment, studies say that individuals should make sure that they remind patients about the progress that they’ve made through the whole process. Seeking help isn’t a sign of weakness, it’s a sign of strength. [21] It shows that they’re trying to treat their disorder. The general public can also help with maintaining a non-judgemental attitude, which can help as well, because patients know that their obsessions are irrational. Finally, the Victoria Department of Health recommends encouraging patients and rewarding them for the gains they’ve made. Most importantly, accept patients for who they are, and don’t ridicule them for their rituals. Supporting a patient with OCD is the best thing to do when they’re going through a difficult time. 

Works Cited:

[1] Benenden Health. (n.d.). OCD: Myths vs Reality. Benenden Health. Retrieved May 7, 2021, from https://www.benenden.co.uk/be-healthy/mind/ocd-myths/ 

[2] Smith, M., Robinson, L., & Segal, J. (2021, February). Obsessive-Compulsive Disorder (OCD). Help Guide. Retrieved May 7, 2021, from https://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm#:~:text=Common%20compulsive%20behaviors%20in%20OCD,senseless%20things %20to%20reduce%20anxiety. 

[3] Ryback, R. (2016, May 9). 4 Myths About OCD. Psychology Today. Retrieved May 7, 2021, from https://www.psychologytoday.com/us/blog/the-truisms-wellness/201605/4-myths-about-ocd 

[4] Pronghorn Psych. (n.d.). How Obsessive Compulsive Disorder Affects the Brain. Stone Ridge. Retrieved May 7, 2021, from https://pronghornpsych.com/how-ocd-affects-the-brain/#:~:text=Researchers%20know%20that%20obsessive%2Dcompulsive,known%20as%20 the%20ventral%20striatum 

[5] Mind. (2019, May). Obsessive-compulsive disorder (OCD). Mind. Retrieved May 7, 2021, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/about-ocd/

[6] ADAA. (2021, October). Facts & Statistics. Anxiety and Depressions Association of America. Retrieved May 18, 2021, from https://adaa.org/understanding-anxiety/facts-statistics#:~:text=Crisis%20(Oct%202020)-,Obsessive%2DCompulsive%20Disorder%20(OCD) ,cases%20occurring%20by%20age%2014.

[7] Heinz, A. (2019, October 7). Survey: Americans More Annoyed With Clutter Than Dirt. Apartmentguide. Retrieved May 18, 2021, from https://www.apartmentguide.com/blog/americans-annoyed-with-clutter/

[8] George, N. (2014, September 3). When It’s Not Just OCD. Everyday Health. Retrieved May 10, 2021, from https://www.everydayhealth.com/news/when-its-not-just-ocd/?pos=2&xid=nl_EverydayHealthMentalHealthandMoodDisorders_20171015 

[9] Gallagher, W. (2017, October 23). You’re Actually Not “So OCD,” And Here’s Why You Shouldn’t Joke About It. Rolling Hills Hospital. Retrieved May 10, 2021, from https://rollinghillshospital.org/youre-actually-not-ocd-heres-shouldnt-joke/#:~:text=Unfortunately%2C%20for%20about%202.2%20million,OCD%20is%20no%20laughing %20matter.&text=You%20may%20not%20realize%20it,who%20deals%20with%20the%20disorder 

[10] Steber, C. (2018, January 30). 7 Symptoms That Are Wrongly Mistaken As OCD. Bustle. Retrieved May 19, 2021, from bustle.com/p/7-symptoms-that-are-wrongly-mistaken-as-ocd-8026866 

[11] D’Arcy-Sharpe, A.-M. (2020, January 6). Why Is OCD So Misunderstood And Misdiagnosed? IMPULSE. Retrieved May 19, 2021, from https://impulsetherapy.com/why-is-ocd-so-misunderstood-misdiagnosed/ 

[12] Charlotte. (2016, June 23). Living with OCD. Mind. Retrieved May 7, 2021, from https://www.mind.org.uk/information-support/your-stories/living-with-ocd/ 

[13] Queensland Health. (2018, October 10). What is it like to live with obsessive compulsive disorder? Queensland Government. Retrieved May 11, 2021, from https://www.health.qld.gov.au/news-events/news/living-with-obsessive-compulsive-disorder-OCD-symptoms-treatment-Queensland 

[14] International OCD Foundation. (2016, October). OCD – Misunderstood and Misdiagnosed | Orlando OCD Therapist Raises Awareness #OCDWEEK. Ground Work Counseling. Retrieved May 11, 2021, from https://www.groundworkcounseling.com/ocd/ocd-misunderstood-and-misdiagnosed-orlando-ocd-therapist-raises-awareness-ocdweek/#:~:text=A%20misdiagnosis%20of%20OCD%20has,management%2C%20 hospitalization%20and%20inaccurate%20reporting.

[15] Pulse. (n.d.). OCD Rituals: Symptoms and Treatment Options. Pulse. Retrieved May 11, 2021, from https://pulsetms.com/ocd/rituals/ 

[16] Gladwell, H. (2018, January 26). How much time OCD rituals take out of my day-to-day life. METRO. Retrieved May 19, 2021, from https://metro.co.uk/2018/01/26/how-much-time-ocd-rituals-take-out-of-my-day-to-day-life-7259595/ 

[17] Ata, S. (2020, November 2). “So OCD”: The Consequences of Delegitimizing a Disorder. INKSPIRE. Retrieved May 19, 2021, from https://inkspire.org/post/so-ocd-the-consequences-of-delegitimizing-a-disorder/-MHg9RS6V1RColwvc–S

[18] NOCD Staff. (2020, December 15). How Long Does OCD Treatment Take? NOCD. Retrieved May 19, 2021, from https://www.treatmyocd.com/blog/how-long-does-ocd-treatment-take

[19] Gershkovich, M., Middleton, R., Hezel, D. M., Grimaldi, S., Renna, M., Basaraba, C., Patel, S., & Simpson, H. B. (2020). Integrating Exposure and Response Prevention With a Mobile App to Treat Obsessive-Compulsive Disorder: Feasibility, Acceptability, and Preliminary Effects. ScienceDirect. Retrieved May 19, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0005789420300666

[20] Penn Psychiatry. (n.d.). OCD: SOME FACTS. Perelman School of Medicine. Retrieved May 19, 2021, from https://www.med.upenn.edu/ctsa/forms_ocdfacts.html#:~:text=Symptoms%20fluctuate%20in%20 severity%20from,symptoms%20were%20disrupting%20their%20lives.  

[21] Obsessive compulsive disorder – family and friends. (n.d.). BetterHealth. Retrieved May 27, 2021, from https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/obsessive-compulsive-disorder-family-and-friends 

[22]Dogra, T. (2020, July 22). Obsessive-Compulsive Disorder (OCD): Symptoms, Treatment And Diagnosis. Onlymyhealth. Retrieved June 1, 2021, from https://www.onlymyhealth.com/obsessive-compulsive-disorder-ocd-symptoms-treatment-diagnosis-1595417322 

About the author

Sophia Zhang

Sophia is a student at the Shanghai American School – Puxi Campus.

The post Obsessing Over Obsessive Compulsive Disorder: The Damage Done by Mischaracterizing OCD appeared first on Exploratio Journal.

Abstract 

How did the lockdown and social media use affect the body image, eating habits, self-esteem, and mental health of adolescent girls? This paper looks at the impacts the lockdown had on social media usage, body image, and eating/exercise habits. Research shows that adolescent girls found themselves with lower self-esteem, depression, anxiety, and disordered eating habits during and after the pandemic. These changes combined with increased social media use that typically promotes unrealistic body expectations and unhealthy eating and exercise habits lead to an overall decrease in young girls’ self-esteem and body image. Based on these findings, we can formulate ways to help everyone with these unhealthy habits if we ever go into lockdown again in the future and even in our normal daily lives as well. 

On March 12th of last year, schools began shutting down saying that they would be closed for the next two weeks out of precaution against COVID-19. Those two weeks quickly turned into three, and then four, and eventually they turned into months. Those months in quarantine were incredibly tough on everyone. Because everything closed down and everyone was stuck inside, peoples’ schedules changed drastically. For Katy, a freshman in high school on the dance team, covid was incredibly difficult. Halfway through her freshman year, her school shut down because of the pandemic. She was forced to do both school online as well as her dance classes. Because she spent most of her time at home, she found herself looking at social media much more often than before. She also began feeling insecure about falling behind on her goals for dance because of the pandemic, and as a result, she followed lots of fitness and dance influencers to try to learn and improve from them. Unfortunately, she only felt more insecure about how she looked and her abilities because those influencers did not post realistic habits. Those influencers she followed promoted unhealthy eating and exercise habits to “be a better dancer”, which led Katy to adopt those habits. Katy continued to feel bad about herself as she decreased the amount she ate and increased the amount she exercised. Katy now struggles with worsened body image and disordered eating habits that negatively impact her physical and mental health. 

How did the pandemic impact our lives? During the COVID-19 lockdown, a survey of U.S. social media users found that 29.7 percent of respondents were using social media for 1-2 hours additional hours per day. This significant increase was due to the extra time spent at home during the lockdown. Everyone’s normal lives were disrupted. Students were forced to do virtual school, many adults were forced to work from home, and many others even lost their jobs due to the pandemic. The uncertainty and confusion of the pandemic led to significant amounts of stress, anxiety, and depression for everyone. 

According to researchers at the University of Michigan conducting a survey from 977 parents of teens, they reported that 1 in 3 girls (aged 13-19) experienced new or worsening anxiety. Additionally, more parents of adolescent girls observed increased symptoms of depression, anxiety, and worry in their kids than parents of adolescent boys. The increase of social media usage also contributed to comparison and unrealistic expectations that worsened people’s self-esteem and body image, which often led to an increase in disordered eating and exercise habits for many. 

Specifically for adolescent girls, the comparison between before and after the pandemic shows the negative impact it had on adolescent girls’ mental health. According to the American Academy of Child and Adolescent Psychiatry in 2018, as many as 10 in 100 adolescent girls had an eating disorder. According to the Anxiety and Depression Association of America, around 25% of teenage girls displayed depressive symptoms. Of the total teenage population taking antidepressants, nearly two-thirds of them are adolescent girls. Therefore, a significant percentage of adolescent girls did have mental health issues and eating disorders in 2018, before the pandemic. Later studies prove that these issues worsened for many with the pandemic. Because their schedules were disrupted and they had more time at home, many adolescent girls adopted or increased their social media usage. Due to the pandemic lockdown and increased social media usage, the eating and exercise habits and in adolescent girls worsened. We can see how worsened eating and exercise habits would impact the mental health and self-esteem of adolescent girls. 

How social media usage affects the body image of young girls?

A research review that examined social media and body image concerns examined that increased social media use leads to more negative body image in young men and women. It specifically shows that appearance comparisons are the direct and important link between the usage of social media and negative body image. 

A research report examined the data from different studies. It showed the correlation between the usage of Facebook and the internalization of thin-ideal media. The study also reports that spending more time on Facebook/Myspace is associated with higher levels of body dissatisfaction and thin-idealization in adolescent girls (ages 14-22). Finally, it showed that elevated appearance exposure, such as posting or viewing, on Facebook was associated with more body dissatisfaction and thin-idealization amongst female high school students as well. 

From this data, we can conclude that heavier usage and interaction on social media such as Facebook is linked to much higher body dissatisfaction. Due to the increase of global social media and internet usage during the COVID-19 pandemic lockdown, we can see how the increase negatively impacted young girls. On many social media platforms, many users tend to edit, photoshop, or alter their photos in order to achieve an “ideal photo”. This is because of the abundant access to photoshop and editing apps online. This allows influencers and other social media public figures to alter their photos to make themselves look more “thin”, “attractive”, or “likable”. Too often, young girls compare themselves to unrealistic social media photos that they are convinced are the norm, and as a result, they feel depressed and dissatisfied when they don’t fit into those norms. Additionally, because young girls are at such a vulnerable age where societal influences can have a strong impact on them for life, these factors are already leaving a destructive impact that will last a long time. 

A study that surveyed 144 girls between the ages of 14-18 years old in the Netherlands and the impact normal and retouched Instagram photos had on their body image proved that the manipulated Instagram photos directly led to lower body image, specifically in those with higher social comparison tendencies. The manipulated photos were also rated more positively than the normal ones. 

This study randomly exposed participants to either 10 original Instagram photos or 10 manipulated photos. Afterward, the participants completed a survey containing various questions regarding their own self-esteem and their opinions about the photos they saw. Regarding the participants’ self-esteem, the study showed that on a scale from 0-6, girls with higher social comparison tendency that were shown manipulated photos had the lowest body image of 3.7. The data shows that 63 participants showed a lower tendency to make social comparisons, and 81 showed a higher tendency to make social comparisons. The participants also said in the survey that they could identify the manipulated photos better than they could identify the original photos. 

From this data, we can conclude that exposure to digitally manipulated photos in adolescent girls, especially those with higher social comparison tendencies, will lead to lower body image in the girls. This is because the participants rate the manipulated photos in the study “more desirable” than the natural photos. Additionally, the data also proves that the majority of the participants could tell that the manipulated photos were manipulated. This shows that the participants are aware of the photos manipulation, yet they still have the tendency to compare themselves to the fake photos. Because manipulated photos are so commonly seen in social media, and the media in general, those with higher social comparison tendencies naturally continue to compare themselves and alter their own images in order to fit into what is deemed “desirable”. As a result, the girls are left stuck with lower body image, which has led and will lead to unhealthy responses, such as depression, over-exercising, and/or disordered eating. 

How did the pandemic impact the eating and exercise habits of adolescent girls?

A study done in Australia compared those with eating disorders to the general population regarding their eating and exercise habits during the pandemic. This study launched a survey on April 1, 2020, in Australia to 5,469 participants, 180 of those self-reporting previous eating disorder history, to determine the changes in eating and exercise behaviors in people during the COVID-19 pandemic lockdown. Between both groups, the groups with the pre-existing eating disorders and the group without pre-existing eating disorders, both groups showed an increase in disordered eating during the lockdown period. The eating disorder group showed an increase in pre-existing behaviors, and the regular group developed disordered eating habits as well. The data is divided into three main groups, the general population, eating disorder, and the anorexia nervosa subgroup.

In total, all three categories reported an overall increase in restricting habits amongst those with previous eating disorders and a slight increase in those without them. For binging, the eating disorder group and general population group both showed an overall increase in bingeing of 35%, while the anorexia nervosa subgroup reported 21% of the participants with an increase in binging habits. Exercise trends are similar for all three groups, there is a significant percentage of the population showing an increase, no difference, and less exercise. For the eating habits reports, none of the categories showed a significant percentage of the population reporting a decrease (<14%), but all of the exercising categories did. 

This study proves that due to the lockdown, those with previous eating disorders increased their disordered eating habits. Additionally, those without previous eating disorders developed disordered eating habits. There could be many reasons for this. For many, the additional time spent in quarantine left them with the time to think about eating/restricting and act on their thoughts. Another factor was the unstable and rapid changes throughout the pandemic. No one knew what the world was going to look like in a few weeks, let alone a few months, and this uncertainty led to lots of stress for many. Another factor of the pandemic was the financial and emotional uncertainty. Many feared losing jobs, housing, food, schooling, and loved ones due to COVID-19 as well. This additional stress may have led to bad coping mechanisms, like obsessing over eating, and exercise habits for the need to feel control over their lives. 

A study conducted in the UK explored how the COVID-19 lockdown influences the eating habits and body image of adolescent girls. 

There are five different categories for the survey data, and participants would rank how well they thought they fit with the categories on a scale of “strongly disagree” to “strongly agree”. The participants were divided into three groups for each category, no (previous) diagnosis, other diagnoses, and eating disorder diagnosis. The first set of data from the survey responses is regarding “difficulty to regulate/control eating”. According to the data, a majority of all three groups said that they agree with the statement. The second category was “more preoccupied with food and eating”. The majority of all three groups also said that they agree with this statement. The next two categories are “exercising more” and “thinking about exercise more”. A significant percentage of each of the groups said that they agree and strongly agree with both statements. The last category is “more concerned about the way I look”. A significant percentage of all three groups said they agree with this statement as well. 

Overall, the data shows that the participants with an alternate diagnosis or an eating disorder had greater difficulty with their relationships with eating, exercise, and body image. At the same time, the people that had no previous mental or ED-related diagnosis reported an increase in negative relationships with eating and exercise during the lockdown. This proves that the lockdown did have a directly negative effect on many different types of people, those with and without a mental diagnosis. While everyone was on lockdown stuck in their homes, many people had lots of spare time on their hands. Specifically for those with an eating disorder/other mental diagnoses, they obsessed over food, exercise, and body image more than they would have when they were busy with their normal lives. Those with pre-existing eating disorders dealt with increased disordered eating habits, more so than the general population and even those with other mental disorders. 

The rapid and unreliable changes in our lifestyles also contributed to increased anxiety amongst many. The fear of losing one’s job, loved ones, or one’s own life during the lockdown was incredibly stressful, which oftentimes led to harmful coping habits like disordered eating or over-exercising. 

Additionally, during the lockdown, there was an overall trend of increased social media usage. This is understandable, given that the main form of communication while in lockdown was through technology/social media. However, the concentrated exposure to misleading/glamorized images may have led people to partake in over-exercising and disordered eating habits which overall, may have worsened their mental and physical health. 

Moving forward, there are many things we can do to help those struggling with disordered eating, body image, and exercise issues if we go back into lockdown again, or even if we don’t. We can help make social media a more safe and real place for everyone. Reminding ourselves that we should not compare ourselves to social media photos is really important. The reality is, we don’t know where these photos came from, they could be photoshopped, edited, and/or posed to look “better”. Additionally, choosing to follow influencers and content creators on social media that don’t promote harmful eating and exercise habits, and blocking/reporting those that do is a great and simple way to prevent being exposed to these harmful ideas. 

If we ever go back into a lockdown again, we cannot control the outside world, but we can control how it impacts us. Trying to cope with tough events using healthier coping mechanisms, such as exercising normally or going for walks outside, is a great way to deal with any stress or anxiety. It is important to look out for ourselves and others during these difficult times, and we must remind ourselves that it is okay to not be functioning at our best because these are not normal circumstances. 

There are many factors that may have contributed to adolescent girls developing/worsening their habits during the lockdown. These factors include dramatic lifestyle changes, stress, previous eating disorders, and mental health issues, excessive social media usage, and additional time spent being stuck inside. All of these factors may have contributed to low self-esteem, body image, eating disorders, and poor mental health in adolescent girls, and many are still dealing with the lasting effects of these issues today. 

References

Published by Statista Research Department, & 28, J. (2021, January 28). U.S. increased time spent on Social due to coronavirus 2020. Statista. https://www.statista.com/statistics/1116148/more-time-spent-social-media-platforms-users-usa-coronavirus/.  

AACAP. (n.d.). Eating Disorders in Teens. Eating disorders in teens. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teenagers-With-Eating-Disorders-002.aspx.  

Girls and teens. Girls and Teens | Anxiety and Depression Association of America, ADAA. (2021, February 5). https://adaa.org/find-help/by-demographics/women-and-young-girls/girls-and-teens.  

Fardouly, J., & Vartanian, L. R. (2015). Social Media and Body Image Concerns: Current Research and Future Directions. http://www2.psy.unsw.edu.au/Users/lvartanian/Publications/Fardouly%20&%20Vartanian%20(2016).pdf.   

Daalmans, S., Kleemans, M., Anschütz, D., & Carbaat, I. (2016, December 15). Picture perfect: The direct effect of manipulated instagram photos on body image in adolescent girls. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/15213269.2016.1257392.  

Phillipou, A., Meyer, D., Neill, E., Tan, E. J., Toh, W. L., Rheenen, T. E. V., & Rossell, S. L. (2020, June 1). Eating and exercise behaviors in eating disorders and the general population during THE COVID‐19 pandemic in Australia: Initial results from the COLLATE project. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23317.   

April 20, 2021 | P. (2021, April 28). How to spot teen depression during covid. Scripps Health. https://www.scripps.org/news_items/5319-teen-depression-during-covid-19-pandemic-what-to-look-for.   

Robertson, M., Duffy, F., Newman, E., Prieto Bravo, C., Ates, H. H., & Sharpe, H. (2021). Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey. Appetite, 159, 105062. https://doi.org/10.1016/j.appet.2020.105062 

About the author

Grace Julian

Grace is currently a Junior at the Episcopal Academy. She enjoys learning about history, psychology, and political science, helps run her school’s political blog, and is a leader of the community service executive board. In her free time, she enjoys playing water polo and reading.

The post Examining the effects of the COVID-19 lockdown on adolescent girls appeared first on Exploratio Journal.

Abstract

This paper investigates why the mask compliance rates were significantly higher in Taiwan than in the United States during the COVID-19 pandemic. This distinction can primarily be represented by an individualist vs. collectivist mindset, associated with Western and Eastern countries, respectively. Mask wearing was influenced by collectivism; Taiwan’s proximity to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic and the subsequent policies implemented; cultural norms; psychological factors including higher risk attitude, sensitivity to social norms, and compliance with personal surveillance; and demographics including race, political ideology, and social class. Mask wearing is negatively associated with infection rates but is not fact based or logical: multiple psychological and cultural factors contribute to this compliance variability. Therefore, those that don’t comply are not purely defiant; individualists and collectivists just have a different belief system in what they value and how they behave. As a paper that explores reasons for noncompliance, from a public policy perspective, the message in compliance requests must be tailored to a specific belief system that serves an individual and group’s best interest while respecting personal values.

Keywords: COVID-19, mask-wearing, culture, individualist vs. collectivist, psychological factors

Why Mask Compliance Differed in the United States and Taiwan During the COVID-19 Pandemic: How Individualist vs. Collectivist Cultures Respond in Uncertain Times

COVID-19, a disease caused from SARS-CoV-2 virus, first detected in Wuhan, China, in December 2019, has been a test of responding to health regulations. Common symptoms include cough, fever, chills, loss of taste and smell, just to name a few. Most cases are mild, with symptoms persisting a few days, but some cases are very severe, requiring hospitalization. The virus has ravaged through borders and taken the lives of millions worldwide. Even though the severity of the pandemic varied by country and demographics, the COVID-19 pandemic was an experience that everyone dealt with. However, the responses, attitudes, and behaviors of the citizens of different countries shed light on how people deal during times of uncertainty. Two contrasting examples include the United States and Taiwan. These two countries have significant differences in mask wearing compliance, defined as wearing a mask when in close contact (within 6 feet) of non household members (Key, 2021).

In a literature search of studies on the mask compliance rates between Eastern and Western cultures, there were multiple studies on the compliance rates and reasoning behind this behavior in Western countries, but limited studies in Eastern countries. This would suggest that because the compliance rates are so high in Eastern countries, researchers aren’t conducting studies on why people complied or how to get people to comply, instead they’re more interested in why people DON’T comply.

According to a study conducted by the University of Southern California’s Dornsife Center for Economic and Social Research, approximately 83% of Americans agree that masks are an effective way to protect themselves from contracting Americans report actually wearing masks when in public places or in close contact with members not of the same household (Key, 2021). Another study found that 64% of Americans that report not wearing a mask responded, “It is my right as an American to not wear a mask” or “It is uncomfortable.” (Vargas & Sanchez, 2020).

The Taiwanese government, on the other hand, instituted a mask mandate with a fine between $100-500 USD for noncompliance (Ministry of Health and Welfare, n.d.; Ministry of Health and Welfare, n.d.). However, there were some reports of non-compliance in some cities in Taiwan. For instance, 604 fines were given in Kaohsiung within 1.5 days (Zheng, 2021) and 848 fines given in Taichung within 2 months (Hong, T. & Lǚ, Z., 2021). Both cities have a population of around 2.7 million, so based on this statistic it can be speculated that the non-compliance rate in Kaohsiung and Taichung is about 0.02% which is still significantly lower than the approximately 50% noncompliance rate in the United States. This finding raises questions on why there is such a big disparity.

The United States has over 330 million people with diverse backgrounds, socioeconomic levels, and beliefs. When the pandemic hit, those outside of the United States saw how a high-income country like the United States dealt with unprecedented circumstances. As of October 2021, the US has over 43 million confirmed cases and 688,000 deaths (World Health Organization, 2021).

Conversely, Taiwan is a densely populated island off the coast of Mainland China with over 23 million people. Due to its proximity to China, where the virus originated, and constant air travel to and from, Taiwan was expected to have the 2nd highest number of cases. However, this was proved to be incorrect. Taiwan along with other countries like Singapore and New Zealand were able to implement policies and community-based preventative measures to slow the rate of transmission and infection rates. By April 2020, the local transmission was at zero (The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, 2021).It stayed that way for about a year. When comparing infection and mortality rates, as of October 2, 2021, the confirmed cases per million people in Taiwan and the United States is 680 and 131,020, respectively. The confirmed number of deaths per million people in Taiwan and the United States in 35 and 2,103, respectively (Ritchie et al., 2020). These statistics illustrate the significant contrast in the severity of the pandemic in these two countries with the US infection rate about 200 times that of Taiwan and the US mortality rate about 60 times that of Taiwan. Why is there such a major difference? How did this happen? What lessons can other countries learn and what do the actions by Taiwan tell us about their attitudes and cultural norms?

Specific factors that can explain why the Taiwanese and Americans responded differently to the pandemic lie mainly in cultural differences. These distinctions include Taiwan’s past experience with SARS, established social norms, different healthcare systems and access to resources, an individualist vs. collectivist mindset that serves as the foundation for psychological factors, and diversity in the population.

Past Experience with SARS: Proximal vs. Distal Threat

Taiwan had a greater proximal distance than the United States did to the SARS epidemic in 2003. General psychological principles suggest that first-hand experience has a greater impact on someone than watching from far away. From Taiwan’s experience with SARS, the government put policies in place for controlling another global health crisis, such as universal mask-wearing, quarantine requirements instituted in February 2020, closing down borders to foreigners in March 2020, and contact tracing systems after the first identified case in China (Taiwan Centers for Disease Control, 2020). However, Americans had no prior experience with a pandemic to this level. Given Taiwan’s past experience in dealing with a health care crisis, the Taiwanese were more familiar than Americans were with healthcare recommendations when these preventative measures were put in place to curb the spread of COVID-19. Additionally, in the beginning of the pandemic, Americans were not directly involved or affected by the pandemic because of its origin in China. This feeling was bolstered by Trump’s rhetoric calling COVID-19 the China virus, resulting in some Americans believing that they could not get the virus because they had limited a relationship with China. For instance, they weren’t Chinese or planning on visiting China soon.

Differences in the Governmental Leadership

Health Care Services

Another reason is the difference in access to health care services. In the United States, there is no universal health care. Universal health care ensures that all citizens have access to health care services when they need it without financial burden. About 8% of the US population is uninsured (Keisler-Starkey & Bunch, 2020). Given the dozens of insurance companies, including in the public and private sectors, Americans pay different fees, resulting in the fragmented health care system that provides them varying degrees of access to certain medical services. The average annual health insurance in the United States is $5,940. This number fluctuates given location and different insurance tiers. Some plans can reach an upward annual cost of $8000 (Price, 2021).

Taiwan, on the other hand, has the National Health Insurance (NHI) System which provides universal health care to 99% of the population. The NHI provides citizens with “SMART” cards, which store a patient’s medical history and records.

After the first confirmed COVID case was identified in China, Taiwan took strict actions to prevent the transmission to its island, given the frequent flights between Mainland China and Taiwan. Taiwan already had a public health agency, the Central Epidemic Command Center (CECC), instituted after Taiwan’s experience with SARS in 2003. The CECC responded to the COVID-19 outbreak and followed pre-established protocols to control a pandemic and had access to other data from various government agencies.

On January 20, 2020, when the CECC was activated, patients’ medical history from the “SMART” cards was integrated with their travel history and data. From there, a system categorized each citizen into high risk or low risk for contracting the virus. High-risk individuals were those who had traveled to high-risk areas, such as Wuhan, and low-risk individuals included those who had not traveled abroad and had no preexisting health condition. After this integrated information was stored on a citizen’s “SMART” card, low-risk individuals were ordered to buy a week’s worth of masks and could live normal lives. High-risk individuals, on the other hand, were sent into a two-week quarantine after which they could join everyone else (Wang et al., 2020; Vox, 2021). Quarantines as such were effective because it controlled the spread and didn’t rely on quarantining only symptomatic individuals, as asymptomatic individuals have a high chance of transmitting the virus before developing symptoms, if they develop symptoms (Summers et al, 2020).

Taiwan also banned foreigners from entering and in March 2020, the CECC categorized everyone flying into Taiwan to be considered high risk so they all had to undergo isolation quarantine. To make sure no citizens left their quarantine facility, the CECC tracked people’s location using cell phone data. There were also daily phone call check-ins to monitor any possible symptoms as well as occasional in-person check-ins (Vox, 2021).Taiwan also instituted a fine between NT $200,000 and NT $1,000,000 (approximately $7000 USD and $36,0000 USD) for breaking quarantine rules (Ministry of Health and Welfare, 2020).

However, studies have shown that only relying on case-based preventative measures such as quarantine and contact tracing wouldn’t have been sufficient for controlling the pandemic. Instead, population-based measures, such as wearing masks and social distancing, were useful in the initial containment of the virus (Ng et al., 2020). Taiwanese attitudes towards wearing masks and having a collectivist mindset, discussed later in the paper, also helped enforce these measures. Additionally, the then Vice President of Taiwan, epidemiologist Chen Chein-Jen, had broadcast announcements to assist citizens in population based measures such as mask wearing, frequent hand washing, and preventing mask hoarding. Similarly, the CECC set a fixed price for masks and used funds and the military to increase mask production. By January 20, 2020, when the CECC was activated, the government had 44 million surgical masks and 1.9 million N95 masks (Wang et al., 2020).With an integrated health insurance system, quarantine requirements, and resource allocation for mask production, Taiwan was organized and prepared to contain the virus.

U.S. Response to COVID-19

Compared to Taiwan’s approach, the United States’ response to the pandemic was completely different. To start off, the federal government put the responsibility of controlling the pandemic onto the state and local governments. This led to a divided nation, with different states instituting different policies, resulting largely from political ideology (Lewis, 2021).

Additionally, during the beginning of the pandemic, there was limited testing and even so, testing criteria was too high, mainly for symptomatic individuals admitted to hospitals, likely to have COVID-19 (Lewis, 2021). The Centers for Disease Control and Prevention (CDC) also released a flawed test, reporting that it could fail 33% of the time (Temple-Raston, 2020). Furthermore, the CDC reported that the spread of COVID-19 likely started in January/February 2020. However, the surveillance systems for detecting the virus and reports of flu-like symptoms were insufficient allowing the virus to spread undetected for more than a month (Jorden et al., 2020).

There was also mixed information from then-President Trump, government agencies including the CDC and the World Health Organization (WHO), and the behaviors from local officials. Examples include Trump’s denial of the seriousness of the virus as well as government agencies changing their message for mask guidance in part due to medical supply shortages for hospitals and health care workers (Molteni & Rogers, 2020; World Health Organization, 2020). The mask guidance during the beginning of the pandemic sent confusing messages for further encouragement of mask-wearing. Until April 2020 for the CDC and June 2020 for the WHO, these agencies only recommended masks for those experiencing symptoms, but it has now been established that the virus can also spread from asymptomatic individuals. Consequently, it creates confusing mask guidance as well as making it hard to know who and which government agency to trust.

Lastly, the US had insufficient contact tracing and quarantine policies put in place, which seen from other countries, such as Taiwan and New Zealand, had a role in attenuating the transmission (Lewis, 2021).

Individualist vs. Collectivist

One way to further understand the striking difference between these two countries is by looking at contrasting social and cultural norms. These perspectives can differ broadly and are learned distinctions in behavior imposed by cultures, through family, friends, classmates, and more. Psychologists that study cultural differences have found a distinction between Eastern and Western culture which provides insight into the difference in pandemic responses. This distinction can be represented by an individualist vs. collectivist mindset, ideas put forth by Markus and Kitayama. An individualist mindset, associated with many Western countries, puts the individual or self above the group. These individuals value and have personal independence. Collectivists, on the other hand, associated with many Eastern countries, have strong social ties and a sense of belonging to their group. Collectivists are more likely to agree that they are willing to sacrifice their own self-interests for the well-being of the group and that their happiness depends largely on the happiness of those around them. Individualists are more likely to agree that they often do their own thing and that whatever happens to them is their own doing, emphasizing the responsibility for personal well-being (Lu et al., 2021).

To illustrate the prevalence of individualist vs. collectivist cultures, in collectivist cultures, it’s more normal to see families of multiple generations living together. In the United States, a record-breaking 64 million Americans live in multi-generational households, including sizable immigrant collectivist populations. Asian and Hispanic populations, many of which are considered collectivist countries, are rapidly increasing in the US. Asians and Hispanics are more likely than whites to live in a multi-generational household, with approximately 29% of Asians and 27% of Hispanics doing so (Cohn & Passel, 2018). This sense of belonging and community from collectivist beliefs, carried over into the United States, include taking care of elderly and 1 putting others’ interests before theirs, such as potentially sacrificing personal health, commitments, or time to help out. Research suggests that collectivists are more likely to care for elderly family members as a means to strengthen family ties whereas individualists are more likely to limit caregiving and use formal social services as a means of support (Pyke & Bengtson, 1996).

This individualist and collectivist mindset can be used to understand how individual and group rights and responsibilities influenced behavior during the pandemic. For example, individual rights include the personal freedom of choosing whether or not to wear a mask and take the vaccine. To further illustrate, an individualist is more likely to say that they don’t want to wear a mask because it’s uncomfortable whereas a collectivist is more likely to agree that discomfort is not a valid excuse for going against group norms. Individual responsibility entails taking care of one’s health, through social distancing and wearing a mask. For instance, an individual wearing a mask for their personal health and not contracting COVID.

Group rights mean that being part of a collective gives access to specific privileges: a right to health care and access to masks and vaccines. Being a member of a group also implies specific behavior expectations. This can include taking the vaccine and following policies such as travel restrictions, quarantine, social distancing, mask mandates, to prevent others from possibly contracting the virus. These important distinctions highlight the different reasons individuals give in mask behavior, with individualists more likely to put themselves before the group and collectivists prioritizing group needs.

Cultural Norms

Even before policies for stopping the spread of the virus were implemented, Taiwan and many other Eastern countries had a norm for wearing surgical masks when experiencing the common cold or similar viruses to protect others and for taking care of the elderly or groups that were at higher risk (Jennings, 2021). So during a pandemic, it seemed normal if not obvious to be wearing masks in public places, on public transportation, and walking around. This mindset and behavior echoes a collectivist mindset present in many Eastern cultures.

For Americans, on the other hand, the preventative measures seemed unusual and unprecedented, since they’ve never experienced a global health crisis to this scale before. Consequently, the pandemic was an anxiety-provoking experience with changes in daily routine, with economic, financial, and health threats, as well as immense uncertainty: lots of unknowns from long-term COVID-19 effects, how to deal with variants, and confusing guidance on preventative measures from government officials and agencies. As a result, the link between behavior and curbing COVID-19 transmission might not have been as straightforward for Americans as it was for the Taiwanese based on different experiences and how the pandemic was handled. Along with the diverse backgrounds of its citizens, the United States found itself divided. As policies such as mask mandates and isolation requirements slowly rolled in, some Americans refused to follow these rules.

Collectivism Predicts Mask-Wearing

It has been well established that masks are an effective way to slow the transmission of COVID-19. Studies have also shown that there is a negative correlation between mask wearing and infection rates. As stated earlier, a USC study reported an approximate 50% mask noncompliance rate in the United States and reports of noncompliance in Taiwan predict an approximate 0.02% noncompliance rate (Key, 2021; Zheng, 2021; Hong, T. & Lǚ, Z., 2021).

Furthermore, studies have also shown that collectivism is positively correlated with mask-wearing. This holds true not only to illustrate the Taiwan vs. United States distinction, but also amongst many individualist and collectivist countries. Countries that scored higher on a reserve-coded scale of Hofstede’s individualism index (represented as a collectivism scale) such as the Philippines, Indonesia, and Thailand, had higher mask compliance rates than individualist countries that scored lower on the scale such as Sweden, The Netherlands, and Finland. These results are after controlling for other factors (e.g., political affiliation and government stringency) (Lu et al., 2021).

This is true not only when comparing the United States to other countries but stays consistent in the United States, with people in more collectivist regions (states and counties) more likely to wear a mask. For instance, states such as New Jersey, California, and Maryland scored higher on the state-level collectivism scale sourced from Vandello and Cohen (1999) and in mask compliance compared to states such as Arizona, Ohio, and Wisconsin, which scored lower on both the state-level collectivism scale and in mask compliance (Lu et al., 2021).

Masks can create physical inconvenience and be uncomfortable. As said earlier, one study found that 64% of Americans that report not wearing a mask responded, “It is my right as an American to not wear a mask” or “It is uncomfortable.” (Vargas & Sanchez, 2020). These actions follow an individualist mindset of protecting personal choice and freedom, but disregard that their actions can affect others (Stewart, 2020). Conversely, collectivists are more willing to put aside their personal inconvenience for the collective welfare and well-being (Biddlestone et al., 2020).

As mentioned previously, there is a $100-500 USD fine for not complying with mask mandates in Taiwan, along with limited reports of noncompliance (Ministry of Health and Welfare, n.d.; Ministry of Health and Welfare, n.d.). In collectivist cultures, the rules are more strict, with hefty consequences for non compliance, because the norm is an expectation to follow the policies implemented. In individualist cultures, on the other hand, the mandates are less strict and more complex and ambiguous because individualists are less likely to comply with rules that sacrifice personal freedom for the well-being and welfare of others. Cultural and personal beliefs can influence how rules are put into place and how people respond.

Additionally, in the US, there is a large divide between democrats and republicans based on their political ideology. Republicans can be seen as more individualist because they value personal freedom and limited government interference in daily personal matters whereas democrats can be seen as more collectivist because they value greater government intervention in economics affairs and a balance between orderly society and liberty. When looking at the difference between mask compliance in democrats and republicans, a striking difference is revealed. Democratically leaning Americans, aligned with collectivist values, have a higher mask-compliance rate than republican leaning counterparts, aligned with more individualist values, have a lower rate of mask compliance (Xu & Cheng, 2020).

To conclude, it is crucial to note that lower mask compliance rates in the United States is not because of Americans being defiant against preventative behaviors, but because of contrasting belief systems and pandemic unpredictability. These findings do not suggest that Americans are associated with various personality traits but instead shed light on the distinct cultural norms affecting behavior.

Psychological Factors

Personal Freedom and Surveillance

Psychological factors, supported by an individualist and collectivist mindset, can also influence mask wearing behavior. The first factor is the idea of personal surveillance. Collectivists are more likely to agree that groups can intrude on an individual’s privacy, especially if it’s for the greater good, since collectivists are more likely to sacrifice their personal freedom for the collective (Bellman et al., 2004). Individualist cultures are more likely to put themselves before the collective to protect their personal freedom, a value that the nation was founded on. This can be seen through the reactions that Americans had towards tracking devices. Before the pandemic, tech companies shared consumer location data with the government to make it easier to track the location of Americans. According to results from a survey in December 2020 conducted on American adults, 42% of the men who responded and 52% of women who responded were very uncomfortable with this (Johnson, 2020). During the pandemic, other companies, such as Google and Apple, used consumer data to track potential exposure to COVID-19. Over 60% of US adults found this COVID-19 exposure tracking tool to be very or somewhat concerning for their privacy (Johnson, 2020).

In South Korea, a collectivist country, government surveillance and tracking has been implemented even before the pandemic. For example, the government has access to credit and bank transaction records to prevent fraud. This system was then repurposed during the pandemic to track where people went, from restaurants to subways. Additionally, because 95% of adults own a smartphone, data location, which was originally used in criminal investigations, is now used for contact tracing. Surveillance footage utilized for investigative purposes and can now provide real time, to the minute, tracking of someone’s location. Koreans can also get sent text messages for outbreak updates. The use of South Korea’s established government surveillance network made it easier to ensure public health safety. Even though there was some talk about privacy concerns, there are limited reports on noncompliance, emphasizing the collectivist tendency to allow personal surveillance for public health purposes (Fendos, 2020).

Risk Attitude

Risk attitude is another psychological factor that affects mask wearing and can be explained through the individualist vs. collectivist mindset. Recent studies show that risk aversion, defined as less likely to engage in risky behaviors, was correlated with compliance to engage in protective behaviors during the pandemic. This was not only true in a pandemic setting but in general, with individuals that have higher levels of risk aversion less likely to smoke or engage in heavy drinking. (Xu & Cheng, 2021).

During a study conducted on Italians, results revealed that emerging adults were more concerned with their relatives and other individuals/community members contracting COVID-19, potentially through them being an asymptomatic carrier, than testing positive for COVID-19 themselves. This collectivist mindset was correlated with a higher perceived risk of infection (Germani et al., 2020). This perceived risk was positively associated with engaging in protective behaviors such as mask wearing and social distancing, a US study found (Duong et al., 2021).

Mask-wearing behavior has similarly been observed and studied in many Asian countries, including Taiwan’s long-standing cultural norm of wearing surgical masks when experiencing symptoms, such as a sore throat and runny nose, as a means to protect others, mentioned earlier (Jennings, 2021).The collectivist mindset and risk perception associated with mask-wearing in different regions can help to support the reasoning behind the Taiwanese mask compliance.

Additionally, as said earlier, amongst the Americans that report not wearing masks, 64% of those Americans said that they didn’t wear a mask because it was uncomfortable or that it’s their right as an American to choose not to wear a mask (Vargas & Sanchez, 2020). An individualist mindset provides reason for these attitudes and behaviors present in some individuals.

Sensitivity Towards Social Norms

The Taiwanese have strong responsiveness to social norms. There is a sense of pressure for wearing masks in subways and public areas. The community will also shame those for non-compliance. For instance, this mentality towards social norms is epitomized in what one Taiwanese said in a CNBC article, “We have this phrase in Taiwan that roughly translates to, ‘This is your country, and it’s up to you to save it’” (Farr, 2020).The government policies also add to this, with hefty fines, up to $500, for non-compliance (Ministry of Health and Welfare, n.d.; Ministry of Health and Welfare, n.d.).

These distinctions can again be supported by an individualist vs. collectivist mindset, in terms of emotional reactions. For example, one study conducted by Matsumoto, Kudoh, Scherer, and Wallbott (1988) found that Americans and Japanese experienced similar emotional reactions but Americans experienced emotions longer, with greater intensity and more bodily symptoms such as verbal reactions, lumps in the throat, breath changes. To conclude the study, more Japanese agreed that acting on these events when coping with these emotional situations was unnecessary, showing a weaker association between emotion and behavior (Scherer, Matsumoto, Wallbot, & Kudoh, 1988). The findings can be expanded out and offer an explanation to how individualists vs. collectivists in the US and Taiwan behaved in mask compliance. The Taiwanese held each other accountable and were less likely to act on their emotions if they didn’t fully agree/want to wear a mask. Americans were more likely to act and go against these mandates, as can be seen through countless protests across many states, even if they had felt similar levels of emotion towards masks as some Taiwanese did.

One of the possible explanations for this is that many of the emotions experienced are ego-focused emotions, meaning they mainly concern the individual’s internal attributes or characteristics. Some examples include anger, frustration, and pride. Therefore, it is logical that individualists are more likely to attend to and act on these emotions than collectivists are, say if they feel their personal freedom is being violated, because these ego-focused emotions are at the heart of an independent self (Markus & Kitayama, 1991). Through the exploration of how psychological factors influenced mask compliance, the prevalence of an individualist vs. collectivist mindset underscores the application to attitudes and behaviors.

Differences in Diversity among Populations

The United States has great diversity with Americans having their own distinct identity, from various demographics, gender, race, ethnicity, and social groups. The United States is rapidly becoming more complex, with data estimates from the US Census Bureau showing that nearly 4 of 10 Americans identify with a race or ethnic group other than white (Frey, 2020; US Census Bureau, 2021). Some Americans then form subgroups with those of similar demographic identities, and base social behavior off of their beliefs and backgrounds.

One way of measuring ethnic diversity is based on an analysis of ethnic fractionalization, the probability that two random individuals from the same country are not from the same group (race, ethnicity, or other criteria). This can be done through Fearon’s analysis in which ethnic fractionalization is on a scale from 0 to 1, with 1 being the most ethnically diverse. When comparing the numbers on Fearon’s analysis, the United States is 0.49 and Taiwan is 0.274 (Alesina et al., 2002; Fisher, 2019).

Diversity is a descriptive factor in the individualist vs. collectivist mindset, with individualism associated with more heterogeneous cultures and collectivism associated with more homogeneous cultures. This diversity in mindset can explain why some states have higher mask compliance rates, as mentioned in the “Collectivism Predicts Mask Wearing” section (Lu et al., 2021).

]From a racial perspective, in a study conducted by USC, the group that was least likely to consistently wear a mask when in close contact with non-household members were whites, with a compliance rate of 46%. Compared to whites, other races including latinos, blacks, and others had higher compliance rates with 63%, 67%, and 65%, respectively (Key, 2021). Diversity in all demographics, from race, locale, and ethnicity, had significant contributions the way individualists and collectivists engaged in mask wearing. This emphasizes the dynamic intricacies of various societies in which no single factor can predict mask wearing.

Conclusion

Culture is an important factor in behavior that has intrigued me as someone who is mixed and spends time with those of various ethnicities, races, and social groups. When the pandemic hit, I spoke to many family and friends that had completely different views on how the virus affected them and what appropriate measures they believed should be taken. At times it was overwhelming and I sought to understand if there was an underlying cultural factor at the root of different attitudes and behaviors. I found that my relatives in Taiwan had one of the most striking contrasts compared to my relatives in the United States in the way they viewed how the government and our societies should be responding.

Since the onset of the pandemic, the infection and mortality rates have been significantly higher in the United States: the US infection rate is about 200 times that of Taiwan and the US mortality rate is about 60 times that of Taiwan (Ritchie et al., 2020). I chose mask wearing as my control factor because it is a universal way to lower the rate of transmission. From talking with my family and friends, I observed that mask-wearing was one of the most heavily debated topics.

The mask compliance rates are significantly higher in Taiwan than in the United States. Through my literature search, I found multiple demographic, cultural, and psychological factors, influenced by an individualist vs. collectivist mindset, that predicted mask wearing. Taiwan’s proximal distance to SARS in 2003 resulted in public health regulations that gave public health agencies access to patient medical and travel records for contact tracing and testing. Along with this, Eastern countries have norms for wearing masks to protect others. Race, locale, and political ideology was associated with mask wearing. Psychological factors involving higher risk attitude, sensitivity to social norms, and personal surveillance compliance were affected by a collectivist mindset. As a caveat, individualism tends to be correlated with Western countries but there is still a large percentage of Americans that do not associate with an individualist mindset. This results in greater diversity within the United States and Americans having differing views of cultural beliefs. Further, Taiwan’s cultural norms and policy preparedness proved to be significant in Taiwanese compliance with preventative measures.

At the heart of a collectivist is having compassion and taking in another perspective by wearing a mask to protect others. On the other hand, a reason individualists are not complying with mask mandates is not because of pure defiance but because they have a different belief system. For instance, for some individualists, it may be harder to conceptualize that they’re part of a collective and that their individual behavior is affecting the group.

These findings are important because it provides insights into how people react to governmental health regulations during times of uncertainty. Neither individualists nor collectivists are “better” than the other. There are specific attributes of each that may better serve during specific circumstances, such as a global health crisis, but I am not stereotyping individualists or collectivists with specific personality traits. I am not here to convince anyone to change their belief system but in global health crises it may be useful to adopt more collectivist actions while also taking steps to protect themselves. This can be achieved without taking away key components of identity and protecting personal values. One big question is how can we get people to comply without making them change their belief systems?

This paper explores the reasons behind noncompliance, so we can get insight into how to frame compliance requests for individualists and collectivists in different manners with the goal of showing that mask-wearing benefits the health of the public. For collectivists, explaining how mask-wearing benefits the group. Ironically, individualists that are not complying with mask mandates are presenting potential health risks to themselves and the group; these individuals are more likely valuing personal freedom over health. When framing compliance requests for individualists, it may help to emphasize that wearing masks acts in their own interests as well as establish the link between individual behavior and group health. These changes in reframing requests appeal to the individualist and collectivist belief systems while respecting personal values.

It is also important to note that extreme collectivism and extreme individualism can also harm self-interest. To further illustrate, extreme collectivism is primarily not taking into account individual needs and extreme individualism is solely focused on personal desires. Neither of these extremes act in one’s best interest because it fails to take into account other perspectives and people.

To conclude, in everyday experiences, it’s good to find some common ground. That way different perspectives can be acknowledged to create a more informed and dynamic view of the world. Sometimes it’s better to be an individual, sometimes it’s better to be a collectivist. In general, it’s hard to change belief systems to adopt other views but being able to empathize and understand why people are the way they are is beneficial not only in a pandemic, but in daily life.

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About the author

Alena Powell

Alena is a senior at Avenues: The World School in NYC. She is passionate about the social sciences, public policy, and global/cultural studies. Her academic interests are interdisciplinary and experiential as she hopes to continue immersion in different cultures, learning about various economic and government systems, and explore pathways to apply her knowledge through social impact.

The post Why Mask Compliance Differed in the United States and Taiwan During the COVID-19 Pandemic: How Individualist vs. Collectivist Cultures Respond in Uncertain Times appeared first on Exploratio Journal.

Background

In society, more and more people spend a large amount of their time on social media. Social media serves as a platform for people to socialize, present themselves and stay connected with their surrounding. Social media offers a variety of advantages to society, such as the convenience to communicate instantly despite geographical barriers, connect with people of the same interest and allows individuals to be constantly up to date with news and other events happening in the world. However, there are also many negative aspects that underlie the use of social media. One such emerging negative phenomena is the fear of missing out, also known as FOMO. It refers to a psychological state in which people become anxious that others within their social spheres are leading much more interesting and socially desirable lives [1]. Also, many people constantly update their information and check for new messages. The more time these people spend checking these messages and search for stimuli such as photos, videos and content, the more they are wasting their valuable time and it has even generated a rather novel mental health issue which is social media addiction [2]. Further, it has been suggested that social media use not only relates to addictive behaviours but also to distraction while working, neglect of the relationship with real-world friends and family members and hence contribute to negative social life.

Personality is a stable, organized collection of psychological traits and mechanisms in the human being that influences his or her interactions with their psychological, social and physical environment [3]. The Big 5 Personality Test is one of the most established methods to assess and describe one’s personality. According to the Big 5, people’s personality can be divided into 5 distinct personality traits: openness, conscientiousness, extraversion, agreeableness and neuroticism [4]. Extraversion is related to whether the person is more likely to express his emotions or hide his feelings and more sociable. Agreeableness has to do with the ease of getting along with someone. People high on the conscientiousness dimension tend to be disciplined and organized. Openness is related to whether the person is imaginative; preferring variety and new things. Finally, people high on neuroticism are more likely to be anxious and insecure, demonstrating a tendency of instability and inconsistent mood. 

On the one hand, personality can be related to well-being within individuals depicted in social behaviours observed in society. For example, people who are high in agreeableness would like to help others. People with high openness are more likely to listen to others’ suggestions which contribute to progress. Personality also relates to trust and interpersonal behaviours. For example, a study showed that Facebook users scoring high on extraversion and low on agreeableness tend to use more other protection strategies besides the management of privacy settings when using the social media platform [5]. Interestingly, extrovertive individuals have been found to engage more in seeking social support but also in avoidance behaviour compared to introvertive subjects [6]. As previous studies suggest, openness is positively associated with pro-environmental attitudes and behaviors [7]. On the other hand, personality can also be related to negative behaviors. One study showed that impulsivity was related to risky behaviors in adolescence [8]. Another research indicated that people of peace type and emotional type personality are more likely to conduct unsafe behaviors during construction work [9]. Ackerman et al. (2011) found that Entitlement/ Exploitativeness tendencies were associated with anti-social behaviors that indicate that others should cater to the narcissist’s needs without any expectation of reciprocity [10]. Further, most personality traits do not relate to positive environmental behaviours, such as green IT adoption; conscientiousness was the only trait to relate to improved Green IT adoption [11]. It was also been reported that there were negative relationships between agreeableness and conscientiousness with workplace deviance [12]. Taken together, this suggests that personality can be related to positive but also negative behaviours in society. 

Method

Participants

There were 159 mixed-gender participants (78 females) aged from 16-74 from the various provinces in China.

Measures

Personality was assessed with the NEO Personality Inventory developed by Costa and Macrae in 1987 which experienced two revisions. The Chinese version of this questionnaire was revised by Zhang (1996). It consisted of 25 questions that outlined 5 different personality traits: Adaptation, Socialness, Openness, Altruism and Morality (5 question per sub-scale of personality). Responses were given on a 5-point Likert-type scale (1-5) and higher values indicate higher tendency of the respective construct (except for adaptation, in which higher numbers indicate lack of adaptation). The Cronbach’s alpha values for all sub-scales produced values of acceptable internal consistency; Adaptation: α= 0.588, Socialness: α = 0.582, Openness: α = 0.573, Altruism: α = 0.712 and Moral: α = 0.704.

Procedure

The data was collected online. The edit and release of the questionnaire were powered by www.wjx.cn and most responses were given on Wechat.

Statistical analyses

All analyses were conducted using SPSS (IBM, version 26). independent-sample t-tests and correlational analyses were used to explore the associations between personality, social media use and social behaviours. 

Results

Descriptives

The present sample consisted of 159 participants aged 33.10 years (SD = 12.64; range: 16-74) of which 81 were male (50.9%) and 78 were female (49.1%). Table 1 depicts the mean personality trait measures for the whole sample and by gender. Independent-sample t-tests were conducted to explore whether there were any gender differences in the five personality traits. The results revealed that females were significantly scoring higher in socialness (p = 0.005), altruism (p = 0.003), morality (p < 0.001) and in adaptation (p = 0.015). This suggest that females seems to be more social, more altruistic, act more according to moral standards and adapt better to situations than males. There was no difference between males and females in openness (p = 0.088).

Personality in relation to social behaviours

Five independent-sample t-tests were conducted to explore whether people who in scenarios are more helpful or not show differences in personality. The results revealed that there was a significant difference in adaptation between people who were helpful and not helpful, t(157)=4.227, p<0.001; participants who reported being more helpful in the scenarios had a tendency to have lack of adaptation (M=16.66, SD = 3.19) than participants who reported not being helpful (M = 14.58, SD = 2.65). There was no difference in socialness between helpful and not helpful participants, t(157)=-1.385, p=0.168. The results revealed that there was a significant difference in openness between people who were helpful and not helpful, t(157)=2.226, p=0.027; participants who reported being more helpful in the scenarios had a tendency to be more open (M=16.40, SD = 3.10) than participants who reported not being helpful (M = 15.27, SD = 3.16).The results revealed that there was a significant difference in altruism between people who were helpful and not helpful, t(157)=-3.362, p=0.001; participants who reported being more helpful in the scenarios had a tendency to be less altruistic (M=10.49, SD = 2.92) than participants who reported not being helpful (M = 12.20, SD = 3.38). The results revealed that there was a significant difference in moral between people who were helpful and not helpful, t(157)=-4.196, p<0.001; participants who reported being more helpful in the scenarios had a tendency to less moral(M=10.82, SD = 3.32) than participants who reported not being helpful (M = 13.13, SD = 3.46).

Personality in relation to social media

Five independent-sample t-tests were conducted to explore whether people who use WeChat and those using other platforms show differences in personality. The results revealed that there was a significant difference in socialness between people who use Wechat and those using other social platforms, t(157)=-2.449, p=0.015; participants who reported using WeChat seemed to be less  social (M = 13.92, SD = 3.09).) than participants who reported using other platforms (M=15.64, SD = 3.93). The results revealed that there was a significant difference in openness between people who use Wechat and those using other social platforms, t(157)=2.044, p=0.043; participants who reported using Wechat seemed to be more open(M=16.19, SD = 3.04) than participants who reported using other social platforms(M = 14.80, SD = 3.57). The results revealed that there was a significant difference in altruism between people who use Wechat and those using other social platforms, t(157)=-2.173, p=0.031; participants who reported using WeChat seemed to be less altruistic(M = 10.90, SD = 2.98)than participants who reported using other social platforms (M=12.40, SD = 4.04). The results revealed that there was a significant difference in morality between people who use Wechat and those using other social platforms, t(157)=-2.093, p=0.038; participants who reported  using Wechat seemed to be less moral (M = 11.44, SD = 3.45).  than participants who reported using other social platforms (M=13.04, SD = 3.83).

Correlation analyses were conducted to explore whether hours of SM use and use before sleep were related to personality.  The results showed that there was a negative correlation between lack of adaption and daily hours of SM use, r = -0.229, p = 0.004, suggesting that people who are less adaptive spent more time using social media per day. There was a positive correlation between socialness and daily hours of SM use, r = 0.201, p = 0.011, suggesting that people who are more social spent more time using social media per day. There was a positive correlation between moral and daily hours of SM use, r=0.219, p=0.006, suggesting that people who are more moral spent more time using social media per day. The results showed that there was a positive correlation between socialness and hours of SM use before sleep, r=0.222, p=0.005, suggesting that people who are more social spent more time using social media before sleep. The results showed that there was a positive correlation between morality and hours of SM use before sleep, r=0.191, p=0.016, suggesting that people are more moral spent more time using social media before sleep.

Discussion

The aim of the present study was to explore to what extent personality was related to social media use and social behaviors. From the study, it has been found that individuals who were more open, lack adaptation, were less altruistic and less moral were more likely to engage in helpful behaviors. At the same time, people who were less social, more open and less altruistic tend to use WeChat instead of other social platforms. People who were less adaptive, more moral and social spent more time using social media every day. People who were more social and moral spent more time on social media on average before sleep every day.

Through the results, it is found that helpful people are more likely to be open, lack adaptation, are less altruistic and less morality right. It is plausible that those who are open tend to conduct helpful behaviour. Openness depicts the quality of not being confined or covered; open people like to explore things and are curious about their surroundings. They like to pursue adventures, new experiences and changes.  Meanwhile, they may want to connect with new people and probably would achieve this by helping others. According to one study, there was a positive relationship between openness to experience and various dimensions of organization-citizenship-behaviours including interpersonal helping, individual initiative, personal industry and loyal boosterism [11]. Nevertheless, it is unclear why the present study found that people who lack adaptation were more likely to conduct helpful behaviours. Adaptation is the process of changing something to suit a new situation and people who lack this ability cannot blend into new environments easily. They tend to be more sensitive and reactive, neurotic and easily depressed and anxious. They can interpret normal things as threatening and have unstable emotional status. Hence, when somebody needs help, people who lack adaptation are likely to worry about whether it is a fraud or not and might expect the worst outcomes behind their behaviors. Also, it is already difficult to solve their own emotional problem, so they may have no energy left to help others. As a result, it seems unlikely that people who lack adaptation tend to conduct helpful behaviors. Altruism is showing concern for the well-being of other people rather than for yourself and it is consistent with the term “helpful”. However, according to the survey, people who conduct helpful behaviour in the scenarios were likely to be less altruistic. Furthermore, as it is morally right to help others, people who were more moral are supposed to conduct more helpful behaviours in the scenarios. Nevertheless, the results turned out to be the opposite of the initial assumption. 

Considering these three results that do not make sense, a possible explanation is suggested. People who are less altruistic and less morality right may imagine themselves to be more helpful and moral because they know being less-altruistic and showing lower moral is usually considered as a bad quality. During the scenario test, the options are of obvious direction to present whether the behaviors are helpful or less helpful. Therefore, when completing the scenario test, those who were less altruistic and less morality right want to justify themselves or want themselves to present in a better quality. At the same time, this tendency might be unconscious to the respondents, which means they actually think as themselves reacting in a  helpful manner. Therefore, these people may choose the answer that makes them seem more helpful although they may not actually behave the same way when the scenario actually happens. Another explanation might be that these people actually know they are less altruistic and less morality right. However, they also own some other personality characteristic that will make them conduct helpful behaviors at the same time, such as openness as mentioned above. The extent of influence of those good quality aspects exceeds that of their personality of being less altruistic and less morality right. As a result, they are more likely to conduct helpful behaviors under such circumstances. Finally, a third explanation can be due to potential flaws in the questionnaires for the personality test which might not depict stable personality traits in the participants. 

Several limitations need to be acknowledged. When employing questionnaires to test the personality of people, some options are repetitive so that the result of the personality test can probably be inaccurate as individuals might engage less in the items of the questionnaire.  One major flaw that was discovered post data collection period was the directions of response scales within some of the items. Specifically, responses were provided on a scale 1 to 5, depicting a degree of increasing to decreasing tendency. This suggests that individuals who scored higher values, showed a decreasing tendency of a specific item component. However, it seemed that a few items had the opposite direction of the scale, which might have made respondents confused and the results potentially inaccurate. The constructs were computed based on the original NEO Personality Inventory developed by Costa and Macrae in 1987 as per Chinese version by Zhang (1996), however, it was concluded that some of the constructs might have required reverse-coding of the scaling for the tendency of the items to be correct.

Furthermore, some descriptions of the words were not clear. For example, in the scenario test, which some scenarios seemed to assess helping behavior, there was one scenario (“someone pushes you”) which seemed to assess the extent of aggression rather than helping behaviour. Nevertheless, these scenarios are all concluded to whether the behavior is helpful or not. In addition, the sample in the present study only included limited working areas, mainly within the construction industry and it would have benefitted to incorporate a more wide-ranging sample from various industries.

To make the results be more plausible, personality can be measured from various angles, such as subjective and objective assessment. Specifically, the personality test can be conducted among a group of participants first (based on self-report measures), followed by assessment about these participants by their friends to gauge whether their perceived personalities are in line with the friend’s perceptions. If the result of the personality test does not match with both the perception of the friends and respondents themselves, it may partly explain why the results in the scenario test do not make sense. It might be because there are some flaws and mistakes in the personality test. Alternatively, more qualitative data can be conducted to explore the reasons for selecting certain options to understand these seemingly unreasonable results (for some of the findings that were unclear). Now that it was established that there is a relationship between personality and helpful behaviors, future studies could explore the relationship between personality and other good/bad behaviors such as honesty and faith/smoking and drinking. Ultimately, this is useful to know as it might provide opportunities to prevent some bad behaviors from happening in advance and select the right people to conduct good behaviors to some degree.

To conclude, the present study explored the relationship between personality, social media use and social behaviors. The findings were somewhat clear and unclear, suggesting that openness related to helpful behaviours; a finding that seems appropriate given the characteristics of openness. However, some of the other personality traits seemed to lack coherence in the way how they can relate to helpfulness and future research is warranted that investigates these associations further, with methodologically strong designs, using appropriate measures of personality and social behaviours.

References

Mentor: Dr. Bianca Serwinski, Northeastern Univeristy

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About the author

Scarlett Chai

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